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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# I Y ‘ t®1 - ®®Z <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: 'O Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. 151.610(- <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 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone //A-U-0 <br /> Number of Stories Overlay/Agreement k LI 0 <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use Attkpia— <br /> Type of Construction Residential Use (.J/4— <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: / <br /> Fire Sprinklers: ❑Update Existing El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes piNo <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? DYes 0 No DEverett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 3 66"q,470 <br /> Approved By: 1 Date: jft `LDS <br /> PUBLIC WORKS <br /> Intake OK by: r t-. Date: 4// .1/9 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ChrA <br /> ►.1:E'a-.e 4— -r 1 ❑Sys Dev-Eval ❑Traffic Mit Eval <br /> ❑SiteiNark or Drainage Proposed <br /> f pito P�ry�.. "`41144-14-S ElBaek#iew-Prevention for high hazard: <br /> Approved By �/ Date: o l Q 1\2e1, s <br /> W P G (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ItgRaute 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 DFire 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 coin 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: Publi Works has no scope---PW Not Required <br /> ••• al Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />