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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# VAIC‘Og—054- <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> r <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 0 Hold in Planning File Drawer / <br /> Y <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑ ❑Yes , 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: DUpdate Exi ig ONew System ❑Not Req'd Planning/Landscape/'Inspection Required before Final? DYes ❑No <br /> Reason Sprinklers Require( "In Lieu" Fee:Type:/ Amount$ <br /> Fire Alarm: ❑Update r sting ❑New System [hot Req'd School Impact Fe Total $ <br /> Reason Fire Alarm Requi Calculated: Credit: <br /> RCW 64.55 MF worksheet r d for permit? DYes ❑ No ❑Everett Sc ' of Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs req :d prior to final? DYes ❑No Additional N es: <br /> VALUATION CALCULATI Total$ 3 iloca..v° <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: �tJ Date: 812(v J Zo I9 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if. <br /> ...WA LA— iSiL,,-% 4tA &,•= ❑,/Sys Dev Eval ❑Traffic Mit Eval <br /> w Q-- -A,\ej -9i-_- z ApU,Site Work or Drainage Proposed <br /> Approved By: D: /Q u�LO�` 1714-...,WI- =- <br /> ' -tpizz�SS ❑Backflow Prevention for high hazard: <br /> 5aG- 5Tc2_.,,___;v1,.44__ CALLS (dental,medical,animals,mortuary,hospital, <br /> 'Pp-6-\ho'.SLY So;2. ),...(t7r€:;.•rt7 supportive housing) <br /> FIRE DEPARTMENT Okoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittais'Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire 5i arm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: / Ei-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-Bui Plans-NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No F. e Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Insp ction 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: <br /> Approved By: Date: Approved By.:., ...,:-.-7.7 Date: >/ 3-/i ' <br />