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0 • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ej\C:)(o Ot LA <br /> BUILDING PLANNING <br /> Intake OK by: Date: 6 7/7//7 Intake OK by: Ale Date: (0 /i 7/i G, <br /> Intake Comments: Intake Comments: Assign To:4(flv <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> 0 Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size r Li SG 5 R Pl.-Hold in Planning File•Drawer <br /> Garage/Accessory Struct. Size 4f-( 3 5,r, Zone --1 <br /> Number of Stories 2- Overlay/Agreement <br /> Basement l►-A No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction ' -Q Residential Use S'r12- <br /> Occupancy Group R-7u Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? i5 es ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: e Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: ttal $ /LI,2s•er) <br /> Reason Fire Alarm Required: Calculated: / SFAX l 4,ZSb Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Et No 4PEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes Q.No Additional Notes: <br /> VALUATION CALCULATION: Total$ 2 32,Ee 0 <br /> 1"7SG (21 2 t 1 to co <br /> 4 i 3 @ `Ig I of 1 S Z 9' Approved By: Date: €(Z E I(Ci <br /> .Q PUBLIC WORKS <br /> Intake OK by: _� IE-4 Date: eiiyiz e1q <br /> Additional Notes: ZO/S lea 4 wS 6 Intake Comments: PW Worksheet Needed if:it /'A,s'U NrS s Dev Eval lifTraffic Mit Eval <br /> Site Work or Drainage Proposed <br /> ApprovedBy: Date: `�Dva� I r Backflow Prevention for high hazard: <br /> °` /($/Iq (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT2oute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: This project also has a separate concurrent PW Review(Green Folder) <br /> OFire Sprinklers ❑Fire Alarm ❑Other: ANDECreate Green Folder ❑Submitted Previously ODeferred <br /> Additional Notes: KThis Permit is Approved by Public Works <br /> IRSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: RA Separate PW Permit is Required (Permit#: PW I906,Q1' ) <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 El Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection 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: I <br /> Approved By: Date: Approved By: ,BUT Date: -1 I?' wig <br />