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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#13 I tO V\ <br /> BUILDING PLANNING <br /> Intake OK by: f� Date: '0 5f 1"l Intake OK by: Date: <br /> Intake Commen. Intake Comments: Assign To: <br /> ewOWWW UP TY pg v. "rat'es <br /> El Route to Commercial Building 0 Attach to Project No. <br /> ❑ R.- - to Residential Building 0 Route to Historic Reviewer <br /> ❑ / - his a"W" Permit <br /> 0 OK to Route to Other Departments <br /> Bld! •'•do/Rem Size 45-'27 4-f 2 0 Hold in Planning File Drawer <br /> Gar--. Accessory Struct.Size i- Zone 'Z-Z L <br /> Number of Stories Co Overlay/Agreement • ..L. <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use C,'I N1 C . <br /> Type of Construction IC-- p Residential Use <br /> Occupancy Group lJ Proposed No. of Dwelling Units: <br /> Occupancy Load 2. I Total No.of Dwelling Units: <br /> Fire Sprinklers: glUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? Yes [gNo <br /> Reason Sprinkl rs Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: 1141Update Existing ❑New 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 #y No DEverett School Dist ❑Mukilteo Scho Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes I�INo Additional Notes: ,ex .ced , , <br /> VALUATION CALCULATION: Total$ , i IVO 0-5 _ d)r t+ 4:,,,, ` as <br /> Approved By: 1�, Date: 46.-S--11 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Date: l I 14i1 ❑Backflow Prevention for high hazard: <br /> Approved By: <br /> l� i (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute 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 ❑Fire Alarm ❑Other. AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is 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: k, E rot„,)( Date: 6,a2O`g Itl Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> tAAt InlOr <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />