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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 6`-1 OS —C1,t <br /> BUILDING 1 PLANNING <br /> Intake OK by:..--1-1_„...- Date: 5 - 1 <br /> — .� Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size c' /7 l c ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone u,L' <br /> Number of Stories „'�xx�� I Overlay/Agreement <br /> Basement X�No ❑Yes , Fin/Unfin Nonresidential Use Vtt � ` ''CX. <br /> Type of Construction V Residential Use <br /> Occupancy Group j Proposed No. of Dwelling Units: <br /> Occupancy Load cgr” Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System LINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes rit,No <br /> Reason Sprinklers Required: - "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System gNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add.'RCW 64.55 docs required prior to final? ❑Yes 'II No Additional Notes: <br /> VALUATION CALCULATION: Total$ /000 <br /> Approved By: Date: 5—. ‘,16,2A\11 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> "��(�E-� <br /> i,�rg�--t OSys Dev Eval ❑Traffic Mit Eval <br /> Kt 6 I)�I ial Site Work or Drainage Proposed <br /> Approved By: ,L f�� Date7r�� J ❑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 /> ❑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(loin 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: "-' t,66 Date: 6- 15 1161 Public Works has no scope---PW Not Required <br /> Additional Notes: g Q \ <br /> /refit( <br /> 1:l�h <br /> F'1rELECTRICAL SSS' &1(t=Tv �, . . <br /> Additional Notes: —n o s E df � pt. <br /> Approved By: Date: Approved By: Date: 5 <br /> 2,01 <br /> Z <br />