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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# b vice <br /> —: • LDINGce,--0 2ciS <br /> a <br /> Intake OK b I , - Date: ��2 `� Intake OK by* Date: U/I 21/el <br /> Intake Commen s: ("N _ ezouk J`mj. n Intake Comments: Assign To:f <br /> itri- <br /> Not605 r <br /> to A-CIG\Pcy <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 3i 77/ ''C" 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone E.-2... <br /> Number of Stories / Overlay/Agreement <br /> Basement 'No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction v1 `B Residential Use <br /> 4-s' <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load /4 A Total No. of Dwelling Units: — <br /> _ <br /> Fire Sprinklers: ❑Update Existing Chew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes Wo <br /> Reason Sprinklers Required: M/, "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: 12 J,IA Calculated: Credit:, <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes LI No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes tiNo Additional Notes: f p jr;or AtriA 0 a-i6 ex iS-±,1 "j- (ilio s'�fC <br /> VALUATION CALCULATION: Total$ 7 /Oil <br /> 4) <br /> Approved By: Le Date: 0!0.41,01 <br /> PUBLIC WORKS <br /> Intake OK by:/ .Date: 4(212.611 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> D,O �14./. ❑Sys Dev Eval ❑Traffic Mit Eval <br /> �� <br /> Site Work or Drainage Proposed <br /> Approved By Date: ❑Backflow Prevention for high hazard: <br /> (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: ❑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 /> 81 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: "-7/6—/ ? Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: f <br /> Approved By: Date: Approved By: AS4Date: gilt. Z6/' <br /> 111 Z <br />