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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# � kO (.. <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> 410 ‘VVY;34 -e-Ae04\S <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 /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.-Size Zone ' — 2 <br /> Number of Stories Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use cEA <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 Inspection Required before Final? ❑Yes ❑No <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? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes ❑No' Additional Notes: <br /> VALUATION CALCULATION: Total$ ` tro O <br /> (o 6 ^^� <br /> Approved Bye — Date: \Q,Cyt,2.(3\,9 <br /> PUBLIC WORKS <br /> Intake OK by: c777, Date: /1 / tiAc;)� <br /> Intake Comments: 'PW Worksheet Needed if: <br /> Additional Notes: t <br /> 1DSys Dev Eval ❑Traffic Mit Eval <br /> I <br /> I❑Site Work or Drainage Proposed <br /> Ap: oved B Date:/0/0//2,/, I 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/Deferre. ubmittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ■ '' e Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑ 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 F 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/Ins ection Scope-ADD FIRE FEE0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By Date: /(,T`Di/ Public Works has no scope--- PW Not Required <br /> dditional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By� Date: /O / 20/A <br />