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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ;3201.,C)---OGE— <br /> BUILDING PLANNING Intake OK by: Date: Intake OK by:I Assign To: f-e'l� Date: 10 /z-7/z <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 /> ❑ Make this a"W"Permit XOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 1.541,409 44-x 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone t— 1 )1/1 VC <br /> Number of Stories CO Overlay/Agreement <br /> Basement 0,No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction 7 ' 11 , V- A Residential Use m V�i i t., <br /> Occupancy Group '�-1-, lit-` Proposed No.of Dwelling Units: 1 / <br /> 'I 0 <br /> Occupancy Load Lpa4- Total No. of Dwelling Units: qb %. <br /> Fire Sprinklers: ❑Update Existing New System ❑Not Req'd Planning/Landscape Inspection Required before Final? Ies ❑No <br /> Reason Sprinklers Required: R.'4 "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing IiINew System ❑Not Req'd School Impact Fee: Total $ tq SI cos-0 <br /> `7 3 osimo -I F`,' bate s <br /> Reason Fire Alarm Required: Calculated: �i�ji;6�'c •'�yl Credit: <br /> RCW 64.55 MF worksheet req'd for permit? E <br /> Yes ❑ No Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? Yes ❑No Additional Notes: <br /> kel o1 i rel.VALUATION CALCULATION: Total$ IS, 1 4-Oi i.044 ,6 246r O _ <br /> (134,62(0) (I►S) = 1 %A`bO/ tso � �� '� <br /> (2 , CR at) ((tpc;)= a i CeeoOi 4141 Approved By: t. Date: 10 <br /> BLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 'DSys Dev Eval OTraffic Mit Eval <br /> OSite Work or Drainage Proposed <br /> Approved By: f7. Date: (,p/?j 12,p,Z,t ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> isupportive 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 /> re Sprinklers EkIre Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 /> O Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> aReview/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: 1 '.Brown Date: `C''3 a?4 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: I <br /> Approved By: Date: Approved By: Date: <br />