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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# " /V(J� <br /> BUILDING PLANNING <br /> Intake OK by: C(/ / <br /> Date: <br /> Z- Jl/? Intake OK byC ' Date: C.O., 2s Zc <br /> Intake Comments: Intake Comments: Assign To: <br /> 9 <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 /> Bldg1TI/Addy elm aize 1.-80 �/� 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Xer Zone - L <br /> Number of Stories 2- Overlay/Agreement <br /> Basement 121-No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction /?j Residential Use St- <br /> Occupancy <br /> rOccupancy Group 12- Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System :blot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ElNo <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? oyes allo DEverett School Dis ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Note • <br /> VALUATION CALCULATION: Total$ SO 000 <br /> Approved �' �� Date: (j_2g. Q1\C\ <br /> PUBLIC WORKS <br /> Intake OK by: 01 ; Date: Ca 2 Qj 4126:ct <br /> <S rr_C- Worksheet Needed if::Intake Comments: PW <br /> Additional Notes: ZJ(� //'L Ws i�� „.►a <br /> +.IEvJ TA-no, ti 450 fi 1:%Sys Dev Eval DTraffic Mit Eval <br /> Mite Work or Drainage Proposed <br /> q <br /> LA— 0-r0.1F-ct— web(2-.e- <br /> Approved <br /> L..Approved By: "' Date: -7/j /0 r.a-cEa.o rL 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 /> DFire Sprinklers DFire Alarm DOther: 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 ❑ 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 ❑ 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: �,,/ Q <br /> Approved By: Date: Approved By: i� tl `� Date: //1h// <br />