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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT <br /> BUILDING PLANNING <br /> Intake OK by: Date: 7/2a l(5' Intake OK by: //14 Date: /2(P/1 4 <br /> Intake Comments: Intake Comments: Assign To: ; (re-fl <br /> jvtsui e. aVu1a y <br /> CGYf-f�r btffi`n Slyioh/re <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 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size (O 13 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Iv/Ps Zone j2-2 <br /> Number of Stories 2 Overlay/Agreement f idt f f4C C <br /> Basement JKINo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction 2.13 Residential Use S92. <br /> "1-41-6449b4.441147 <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: 2 -s 1 <br /> Fire Sprinklers: ❑Update Existing New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes o <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update 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 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ Soy 6 50 <br /> Approved By:- Date: c) 9)11 <br /> 1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: to/5 (f2L !A1 Sl.0 Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> D Site Work or Drainage Proposed <br /> Approved By J '�Ql( yakt. * Date: tp to t lit ❑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 /> D 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: Date: Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Dater = /a/ /I <br />