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• • (�-, <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <9C10©Z"(-05 <br /> BUILDING PLANNING� p� <br /> Intake OK by: Date: Intake OK by: r� Assign To: ►1W Date:. /240/ ) <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W" Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone C <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use per1-l-a I rrr fr CQ_ <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 El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes �p9p <br /> Reason Sprinklers Required: "In Lie ' ee: Type: ____Arrfount$ I <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett S ist ❑Mukilteo-Sslazol Dist <br /> Add'RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 4`41 UC.O <br /> Approved By: Date: ),426/2..„d <br /> 1 � <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑sys Dev Eval ❑Traffic Mit Eval <br /> s❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: / Date: C r./7 /762- (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 /> El Fire Sprinklers ❑Fire Alarm El Other: 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green 'der Join with this folberfor permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued se arat ly(Separate Green Folder, W issued ahead of Bldg) <br /> Approved By: Date: ublic Works has no sco ---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> / <br /> 2�/1 ) <br />