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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �6:1O q r o2-T <br /> BUILDING PLANNING <br /> Intake OK by: Date:_ Intake OK by:446_ Date: l/I 4p y <br /> Intake Comments Intake Comments: Assign To: fi <br /> 4 (;fy i-f Iq('d..sai p e ;Y e-C ron i.S <br /> felu► re.4 . <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> O Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 32.,E-4- 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone e "1 <br /> Number of Stories Overlay/Agreement <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use geSta,vrawi-t- <br /> Type of Construction \<U Residential Use <br /> Occupancy Group 4.- Z Proposed No. of Dwelling Units: <br /> Occupancy Loa 1 - Total No. of Dwelling Units: <br /> Fire Sprinklers: Update Existing ❑New System DNot Req'd Planning/Landscape Inspection Required before Fir.. ❑Yes ❑No / <br /> "In Lieu" Fee: Type:Sprinklers Required: - Amount <br /> Fire Alarm: Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ ,_,./ir <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> f <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 12 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes I No Additional Notes:' _ Ic L n � PP 1 <br /> VALUATION CALCULATION: Total$ i I-tar oat) ' pi;(-s rr� G't I r re C6 0) e <br /> Pc' <br /> Approved By: Date: Grp21I Cif <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 /> ❑Backflow Prevention for high hazard: <br /> Approved By: �= Date: $ I A-1 t� i(dentai,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred SubmittalsRequired: DThis project also has a separate concurrent PW Review(Green Folder) <br /> til Fire Sprinklers Fire Alarm ❑Other: ? -, .; AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <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 /> O 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ,Review I Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: """ ( c) 1 // � Date: 7 /Z 3( / ' 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 /> ,s____ <br />