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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# fi I,011—0 V7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: 4111" Intake OK b Date: _I 1 i te//q <br /> Intake Commen s: Intake Comments: Assign To: NA <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑(Route to Historic Reviewer ,{ f_ <br /> ❑ Make this a"W" Permit 11 OK to Route to Other Departments Role, r•������a 14ni ( <br /> Bldg/TI/Addn/Rem Size /t76 4 ❑ Hold in Planning File Drawer U <br /> Garage/Accessory Struct.Size --'^ 1111 Zone E- I <br /> Number of Stories / Overlay/Agreement WI IA U <br /> tt <br /> Basement �INo Dyes , Fin/Unfin Nonresidential Use mar()U�/-i RQ'I u-( / (_J5.. <br /> Type of Construction (/—B Residential Use IV DN E <br /> Occupancy Group YYI Proposed No. of Dwelling Units: ,&J c+ NC <br /> Occupancy Load /0 Total No. of Dwelling Units: /v13 NE <br /> Fire Sprinklers: ❑Update Existing ❑New System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing DNew System SNot Req'd School Impact Fee: Total $ 0,OE- <br /> Reason <br /> EReason Fire Alarm Required: r� Calculated: Credit: <br /> RCW !64.55 MF worksheet req'd for permit? ❑Yes Dr DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yeso Additional Notes: <br /> VALUATION CALCULATION: Total $ 3"-C.- -DC' <br /> Approved 13‹—C------IFVJ <br /> Date: 1/ 6// /' <br /> PUBLIC WORKS <br /> Intake OK by: . 4 Date: 4 ,� ': r-A. I ?-c.' '.'t <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> -4 LA— 1 4-Ce;- O c>— Sys Dev Eval ❑Traffic Mit Eval <br /> U-40 Rg, ❑Site Work or Drainage Proposed <br /> Approved By: e_E� ,....s— Date: ,214 P/2, /1 - PAO SGoC'c.- ID Backflow Prevention for high hazard: <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 /> ❑Fire Sprinklers El Fire Alarm DOther: 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 /> M4 Review of As-Built Plans- NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder Goin 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:Z.. Date: 4 P124` tlblic Works has no scope--- PW Not Required <br /> Additional <br /> Additional Notes �e.�": -}� - �/t le I�2414 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> (#--D <br />