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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#` eke—\ 'CC)5 <br /> UILDING PLANNING <br /> Intake OK by �ir> — Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments• Accinn Try <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" ermit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn em Si ,� // 4/11) £I 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size .-- Zone <br /> U•C\ <br /> Number of Stories .� Overlay/Agreement _ <br /> Basement ❑No ®Yes , Fin/Unfin Nonresidential Use ScNg.Q,i <br /> Type of Construction •y PZ Residential Use _ <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load ed C0444 h t - Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ZNot Req'd Planning/Landscape Inspection Regyi,red' efore Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: 'byUpdate Existing ❑New System ❑Not Req'd School Impact Fee: . al $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No El Everett ool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ' No Additio,.I Notes: <br /> VALUATION CALCULATION: Total$ ?SQ OGO <br /> Approved By: ' Date: (---\_ON,tO\q <br /> PUBLIC WORKS <br /> Intake OK by: _`" -1-44 Date: 4 i i 1 1`f <br /> Additional Notes: Intake Comment PW Worksheet Needed if: <br /> fiJcs i.14. MAS..% — <br /> cCI 7 -b _ /0-‘97.-t-,643-2—, AL.-- 1,..1-cG"M.,06— -7-% ❑Sys-Bev Eval ❑Traffiic-Mit Eval <br /> AV 5co�i>< ❑Site Woik-oi Drainage Proposed <br /> Approved By: 7�_ Date: `'--62 2-1 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT El 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 OFire 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: ❑A Separate PW Permit is Required (Permit#: PW ) <br /> 'a --view of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> ii Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspectioncope ADD FIRE FEE y 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved Byl '�; P`1--- Date: `f /d 0/ It-Public Works has no scope---PW Not Required <br /> / Additional Notes: <br /> ELECTRICAL �/ 4--1 o J es i 9' <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: a."-"N <br />