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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) . PERMIT# 220 eJ OSt BUILDING 11--.1--- PLANNING Intake OK by: Date: Intake OK by: Assign To: • Date: Intake Comments: Intake Comments: ❑ Route to Commercial Building ❑Attach to Project No. cute to Residential Building ❑ Route to Historic Reviewer ❑ Make this a"W"Permit 0 OK to Route to Other Departments Bldg/TI ddn em Size NO . El Hold in Planning File Drawer Garage/Accessory Struct. Size 7j © ` \ Zone Number of Stories 2 Overlay/Agreement Basement 8No ❑Yes, Fin/Unfin Nonresidential Use Type of Construction Residential Use Occupancy Group -(aA- Proposed No.of Dwelling Units: Occupancy Loader Total No.of Dwelling Units: , Fire Sprinklers: El Update Existing ❑New System CNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes o_ Reason Sprinklers Required: �r1 "In Lieu"Fee:Type: Amount$ Fire Alarm: ❑Update Existing ❑New System SNot Req'd School Impact Fee: Total $ - Reason Fire Alarm Required: Calculated: Credit: RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes IgiNo Additional Notes: VALUATION CALCULATION: Total $ 10, X C) Approved By: IL ,, ,_/ Date: I Z. Z K, 7 ? l"�•. BLIC WORKS Intake OK by: . 9 Date: S I 1I2 2,6L2 Additional Notes: Intake Comments: PW Worksheet Needed if: reatp =EJSys Dev Eval OTraffic Mit Eval ii OSite Work or Drainage Proposed =OBackflow Prevention for high hazard: Approved By: Date: Z I c I22ci. W w(/v _(dental,medical animals,mortuary,hospital, supportive housing) FIRE DEPARTMENT ❑Route thus folder for PW"fielew at end ---PW Review Worksheet Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred Additional Notes: NI This Permit is Approved by Public Works 17,1 See PW Review Worksheet and associated attached items Fire Dept. Fees: ❑A Separate PW Permit is Required (Permit#:PW ) ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) ❑ Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) Approved By: Date: ❑ Public Works has no scope---PW Not Required 1 Additional Notes:nb 0 4tl16 bi/YVh SS�,�, ,.,," f?i col!, ELECTRICAL I ►tjq z/�� Or ►►i on Additional Notes: VViahe Approved By: Date: Approved By: ate: 0fil 1 I'L ?/Z/v