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Intake & Approval Sheet (FOR PERMIT STAFF ONL19 PERMIT# '/qo 7'006 <br /> BUILDING PLANNING �I Q <br /> Intake OK by: Date:��`�l 9 Intake OK by Date: -21-"Ar., 2 1 <br /> Intake Comment Intake Comments: Assign To: - 0\`Q` <br /> g <br /> ❑ Route to Commercial Building Attach to Project No. \� ,\ — c <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 14 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer /jv' Jc <br /> Garage/Accessory Struct. Size Zone :-\ \ <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No DYes, Fin/Unfin Nonresidential Use CTS�«$A/'antc t c-e., ,eA <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes MNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing DNew System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: C . <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No DEverett School Dist Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Not <br /> VALUATION CALCULATION: Total $ <br /> Approved By Date: ys--. Z..Q.Ag <br /> PUBLIC WORKS i i <br /> Intake OK by: ; ' Date: 1v(`=/ / Z )/ri <br /> Additional Notes: Intake Commen/ts�:j� PW Worksheet Needed if: <br /> p �J J/ {� 2' � �/ ❑{Sys Dev Eval ❑Traffic Mit Eval <br /> j ` /OGQ .m ler_ <br /> /'w///1e_' MSite Work or-Drainage tlfeoet dApproved By:\) 5 f' �"` Date: `2 ?_o(� /,L� �; C ❑Backflow Prevention for high hazard: <br /> 4 0074 fJ> % (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT grRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate i Deferred Submittals Required: DThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> RUf Vi r /( 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 1 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 /> ❑ 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 By:11/A1 N iOc Date: <br /> ZIZ: <br />