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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#�A.Q.C(0 sCrq <br /> — <br /> BUILDING `\ PLANNING <br /> Intake OK by: 14Date: _._i • Intake OK by: KA Date: (1-. 20- NIntake Comme ® Intake Comments: Assign To: G. Vbl'(, <br /> ri <br /> -1W \�-ormless 4 Air <br /> ❑ Route to Commercial Building Attach to Project No. Et ._ _+.t' e • •' t IP/I- <br /> OI <br /> ❑ Route to Residential Building Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size Hold in Planning File Drawer rri <br /> Garage/Accessory Struct. Size Zone lJ <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Dyes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group 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 Inspecti• Required before Final? DYes EINo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: DUpdate Existing ❑New System ❑Not Req'd School Impact Fee: T► al $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 0 No DEverett Scho. list ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional No '•5: <br /> VALUATION CALCULATION: Total $ S .C.. 'l\O; `\,1\_ KNX, <br /> Approved B -----:_s --------)A <br /> quAof,c,i wte' ri',VA, O`i <br /> PUBLIC WORKS <br /> Intake OK by: I` Date: G? <br /> Additional Notes: ipev4.0uk-r• u\oGGwL`'"t . Intake Comments: PW Workshe t Needed if: <br /> Sys Dev Eval tSTraffic Mit Eval <br /> � R4..rr <br /> - <br /> l Site Work or Drainage Proposed <br /> Approved By: ij Date: iq p } DBackflow 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 concurren PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: AND NCreate 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: ❑ 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: �'•,Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL _ el 10 C <br /> Additional Notes: r OM V t ( (4 ' to wl 00 0 - (AA-I rito oa1/6 J <br /> Approved By: Date: Approved By: t'Mdc WeAATy 0 I Is' l IG\ <br />