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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# PIN( 1 O D -occl. <br /> BUILDING �,,p� /�/ PLANNING <br /> �1 �j <br /> Intake OK b�2,,4 Date: liq'�L/�.D/9 Intake OK by:b/ Date: V I Z/ice/ <br /> Intake Comments: / Intake Comments: Assign To: fJ(yj <br /> ,'24 rr ja 'lanai} <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑•Route to Historic Reviewer <br /> ❑ Make this a"W" Permit DlOK to.Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone . I nit ki 0 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use Wita'areAt1 J <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 ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing DNew System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No DEverett School Dist ❑Mukilteo SSktool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ -8s ow,Ov <br /> Approved By: /('i3 Date: i/j_/1' q <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: ,;.,,�/,h Date:Q�s/ 7c <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: DThis project also has a separate concurrent PW Review(Green Folder) <br /> DFire Sprinklers ❑Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ODeferred <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 0 Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(joinwiththisfolderforpermitissuance) <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: Date: <br /> (C7"' \\ <br />