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Make &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 6726 Y� t <br /> BUILDING • PLANNING* <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Ad n/Rem`Si t) I Sq 2 GF- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories 1 Overlay/Agreement _ <br /> Basement INo ❑Yes, Fin/Unfin Nonresidential Use , <br /> Type of Construction • 1—Q,e- Residential Use <br /> Occupancy Group Z(1,—, Proposed No.of Dwelling Units: <br /> Occupancy Load �(1,c-- • • Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System &tot Req'd Planning/Landscape Inspection Required before Final? ❑Yes to <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ / <br /> Fire Alarm: El Update Existing El New System Of&ot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes allo El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Oyes IR No Additional Notes: Affb."-CA aS <br /> VALUATION CALCULATION: Total$ 2- 19159 <br /> Approved By: �/ . i I Date: '. 1 b ,'2 3 <br /> 1"' • UBLIC WORKS,- <br /> Intake OK by: Date: <br /> Intake Comments: !PW WorksheetNeeded if. <br /> Additional Notes: I <br /> N fit A- -1 ?❑Sys Dev Eval ❑Traffic Mit Eval <br /> I OSite Work or Drainage Proposed. <br /> Approved By: }� Date: I 2'a I OBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT CI Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ; . This Permit is Approved by Public Works . :: <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: r t <br /> ELECTRICAL ( pwl (`Z.2-V>` 0 <br /> Additional Notes: <br /> Approved By: Date: Approved By: 1 i-- Date: 11Zo23 <br />