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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# 5/61(0 00( <br /> BUILDING \ PLANNING <br /> Intake OK b Datee9/a/'J/Z/9 Intake OK by: �1 1--- Assign To: �elS Date: (0.3.1 I <br /> Intake Commen s. Intake Comments: <br /> a ko ('e,A rA ,e-r C,xf:e"-•4- C a AQ- <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 ►. I K to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size • Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone L" - 2 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use (Cs 4....vrix"4-- <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 PiNo <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 S "ool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: L 10.3k <br /> VALUATION CALCULATION: Total$ <br /> Approved By: O l _c. ' Date: Icy o i %a 11 <br /> PUBLIC WORKS <br /> Intake OK by:—`" Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> =DSite Work or Drainage Proposed <br /> Approved By: Date: \2' 13 tat ❑Backflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary,hospital, <br /> I.supportive housing) <br /> FIRE DEPARTMENT DRoute 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' ,OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 1, rhis Permit is Approved by Public Works <br /> 0 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 F AND 0 Is located in this folder <br /> 0 Minimal or No Fire Scope-NO FIRE FEE ❑ 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: ,< 3 !9 <br />