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• <br /> Intake &Approval Sheet -(FOR PERMIT STAFF ONLY) _ PERMIT# o�(.0 ! -056 <br /> BUILDING . . PLANNING • . ' <br /> -Q�Intake OK by: / Date: q II I72z Intake OK by:2 Assign To:T, 4te Date: 2f/5/2922- <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> Route to Residential Building 0 Route to Historic Reviewer <br /> pMake this a"W"Permit 70K to Route to Other Departments <br /> Bld I/Addn/Rem Size 2A 3 0 Hold in Planning File Drawer <br /> Garage cessory Struct.Size 1- 46 Zone le--S <br /> Number of Stories "Z Overlay/Agreement <br /> Basement RINo ❑Yes, Fin/Unfin Nonresidential Use . <br /> Type of Construction - a=(LC. Residential Use <br /> Occupancy Group 'y Proposed No.of Dwelling Units: <br /> Occupancy Load '01-c- ' Total No.of Dwelling Units: <br /> Fire Sprinklers: ['Update Existing ['New System EtNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: CI Update Existing ❑New System-Sot Req'd School Impact Fee: Total $ .6;04'8 <br /> Reason Fire Alarm Required: Calculated: ,4 Credit: <br /> RCW 64.55 MF worksheet req'd for permit? El 'No ❑Everett School Dist Ll�Jlukilteo School Dist <br /> Add!RCW 64.55 does required prior to final? CI Yes 21No Additional Notes: <br /> VALUATION CALCULATION: Total$ 2$$,S f 5 <br /> LIwl)b SPIN£ - 33th g -411301 / <br /> it26411210 Approved By: (/0 Date: (0.012.0 . <br /> Intake OK by: 651) Date Oi l/,u1O 7/ <br /> Additional Notes: Intake Comments:fret irk " =pW Worksheet Needed if. <br /> ^�,n i <br /> a PW 220l-DL(o ® IDd Sys Dev Eval Traffic'Mit Eval <br /> • `� � EISite Work or Drainage Proposed. <br /> Approved By: e-Qvt. Date: ()tit 31 ZZ ❑Backflow Prevention for high hazard: <br /> ;(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review atjrid - PP Review Worksheet <br /> I I LeinUs -fllt�W <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: 11c.This Permit is Approved by Public Works <br /> [21.See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: Eit A Separate PW Permit is Required(Permit#: PW t2 1iDi(0 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND '/Is located in this folder <br /> VI-Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green.Folder(loin 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: n Date: %-a1-‘,2, 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: ,,l/ i4 41/14.014, Date:1 I'24 2/32Z <br />