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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#bl.4)kROL' -4132.) <br /> BUILDING PLANNING <br /> Intake OK by: Date: td 16(IR Intake OK by: (i Date:cal J of 1)n1^ <br /> Intake Commen 4 j Intake Comments: Assign To: XI <br /> N C j Li)-002_ Ge,r - le-ow-pa-c/11 . <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit I 'OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone U� <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use - -"1 ni-15 <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Require. •efore Final? ❑YesNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing DNew System ID 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 0 No DEverett School Di ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional No = . <br /> VALUATION CALCULATION: Total$ C <br /> Approved By: a/6 Date: L'J-O/ /0' <br /> PUBLIC WORKS <br /> Intake OK by: I It'A Date: Co 10 I 1 9 <br /> Additional Notes:'?plte4i Rte' Intake Comments: PW Worksheet Needed if: <br /> c_E, 'TcatLc_N ❑Sys Dev Eval ❑Traffic Mit Eval <br /> S—yc,s , y ❑Site Work or Drainage Proposed <br /> Approved By: l• Date: /2.6/�R <br /> ❑Backflow Prevention for high hazard: <br /> �yv S ;2-- 6 t sb (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: DThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers El Fire Alarm El 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 0 Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder Goin with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: -ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 021-2— <br />