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intake & Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# )2C0o9 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldc T Addn/Rem Size /77 700 ISF ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size /v/e4 Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement alNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction ^-si Residential Use <br /> Occupancy Group S-1 s-rz ,3; 4 —3 Proposed No. of Dwelling Units: <br /> Occupancy Load 61 Total No. of Dwelling Units: <br /> Fire Sprinklers: ®'Update Existing pNew 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 El 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 In No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ZNo Additional Notes: <br /> VALUATION CALCULATION: Total $,OS'f',&6 Oa <br /> Vi(kiletfYill' <br /> b +J cAS Approved By: yate Date:1 Z\ii I <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 'IPW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved B Date:O 7����f� 3❑Backflow Prevention for high hazard: <br /> I(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: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Fire Sprinklers 1yire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder coin with this folderforpermit issuance) <br /> Review/Inspection Scope ADD F E ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: N� F �/�',lA I I Ly l 1267,6 ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: '.^ � <br /> ELECTRICAL ?.t�., P W C J ' I <br /> Additional Notes: "ID ki tX*016► l 046)1( <br /> Approved By: Date: Approved By: fS.`, ft,(r — f" Date: (5 I Ztuj <br />