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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 9�1b(0--0\ q- <br /> BUILDING <br /> PLANNING <br /> Intake OK by: Date: iq Intake OK by: %vim <br /> Cv Date: `e,I (1;'l 1,1 <br /> Intake Comment • Intake Comments: Assign To: .1 LC,x <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit L ,OK to Route to Other Departments <br /> Bld ' I/Addn/Rem Size 1 770 If 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ' Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement , No DYes , Fin/Unfin Nonresidential Use j ivy I L;r0 <br /> Type of Construction Vi3 Residential Use <br /> Occupancy Group , G " Proposed No. of Dwelling Units: <br /> Occupancy Load _8 11 Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing New System Not Req'd Planning/Landscape Inspection Required before Final? DYes pii No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El 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? ❑Yes ID No ❑Everett School Dist DMukilteo School Dist <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes 1:21No Additional Notes: <br /> VALUATION CALCULATION: Total $ /ZC,Oca. ' <br /> Approved By: (,(/L, Date: i ? (/,./ l - i <br /> PUBLIC WORKS <br /> Intake OK by: " Na Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 4.4E.,,1-Pa2-CA. ' Il ys Dev Eval $-Traffic Mit Eval <br /> w w 'va•,,..,..s .euz s lElite Work or Drainage Proposed <br /> r �Ics J-tI`•-c• s <br /> Approved By ,, Date:'�x/� 7 .p`�+ Backflow Prevention for high hazard: <br /> �! 2i aVg ��� 141'.0-el (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> 5....a.,..",#-c-0— <br /> FIRE <br /> s a.Fe►tSFIRE 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 DOther: AND ViCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> IC QIT IN &I/1�(/(,? 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 /> • inimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 2 '-view/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ` ,LUV- S lyinate: 1 1?)\ l ibi" 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />