Laserfiche WebLink
Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1( 1(1011 (-CAD <br /> BUILDING PLANNING , i <br /> Intake OK by: Date: 21/10 Intake OK by�_... Date: 2'-i• to <br /> Intake Comments: Intake Comments: Assign To: 'C.& QO`l <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> El 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 e'm ize J235 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories ( Overlay/Agreement <br /> Basement EiNo DYes, Fin/Unfin Nonresidential Use `, <br /> Type of Construction aZ� Residential Use SF A-60 c' A SOA <br /> Occupancy Group g.. Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes giNo <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: -• : <br /> RCW 64.55 MF worksheet req'd for permit? DYes LEI No ❑Everett School Dist MI Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ®No Additional Note.. <br /> VALUATION CALCULATION: Total$ 23, 7e,S <br /> Approved Byr-- J Date: 62_ V- . 2 c' \01. <br /> PUBLIC WORKS <br /> Intake OK by: T' Date: 4 (z 4 / 19 <br /> •F <br /> Additional Notes: 20/5 /,L )..ciEC Intake Comments: Worksheet Needed if: <br /> C4.4 V Cc--r SFcL- Ta Sys Dev Eval ❑Traffic Mit Eval <br /> / Drou--'t �°��`'�` -' v4oM'&DSite Work or Drainage Proposed <br /> Approved By: — Date: 5//41( pa�W ?+�M 49 .,g.4 OBackflow Prevention for high hazard: <br /> �"!!! Lje S5 --n.k4 2b O SF (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT PRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> DFire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: V.-Ihis Permit is Approved by Public Works <br /> r t"I Peil/tA <br /> ztSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW <br /> O 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B � Date: co 7/i_izeu 9 <br />