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hitake &Approval Sheet 1 di (FOR PERMIT STAFF ONLY) PERMIT# &ZOO? —o(3 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: ,,5 � Intake Comments: <br /> C/W V <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> 1 <br /> Bldg/TI/Addn/Rem Size /g)Z1 ‘0 �F El Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /t//,4 Zone <br /> Number of Stories p Overlay/Agreement <br /> i <br /> Basement , No ❑Yes, Fin/Unfin Nonresidential Use • <br /> Type of Construction -2'-'A /t/-4 Residential.Use <br /> Occupancy Group ,Q."Z, 7 t f I)i l ,S�,A 2 Proposed No.of Dwelling Units: <br /> Occupancy Load f 6 Yts Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing l.E6New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing aNew System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes /a No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? , Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 2/•6 /n WI/at <br /> Approved By: A t tim 4 i , .ems Date: bl t GI I Za & <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> • <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> iE1Sys Dev Eval OTraffic Mit Eval <br /> il]Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved B Date:[ 0/rile <br /> :(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE.DEPARTMENT • ❑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 /> 10Elfe Sprinklers Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ; . de' (This Permit is Approved by Public Works <br /> KSee PW Review Worksheet and associated attached.items <br /> Fire Dept.Fees: gA Separate PW Permit is Required(Permit#:PW Ft 12__o f ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE Kis in a Separate Green Folder(join with this folder for permit issuance) <br /> Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ,, wn Date:']-/f24Z El Public Works has no scope---PW Not Required <br /> Additional Notes: Issue_ Gfe .pCui'gi2..--( 8 A iokftr�f <br /> ELECTRICAL <br /> Additional Notes: <br /> . . . � 26/ <br /> Approved By: Date: Approved By: , Date: L <br />