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Intake & Approval Sheet (FOR PERMIT STAFF ONL19 PERMIT# S .°:::k 05 0°2 <br /> BUILDING PLANNING <br /> Intake OK b • Date:O4dZ/ZD/7 Intake OK by: Date: 5/2/ii <br /> Intake Comments: Intake Comments: Assign To: Nib 1 5 <br /> —f 0C-tIE Tv Ui7(v/ /'l, njee_ai dQcl3tc41 otacunAcirrt <br /> jEr Route to Commercial Building Q Attach to Project No. V III 5_ O22 <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 'OK to Route to Other Departments <br /> BldglTI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone ,*..-f <br /> Number of Stories Overlay/Agreement N I <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use :L-.13f100 I <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 ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: 4/ Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ 4 jPT <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I ROW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: Se.V1et NOT 10--11 Wt.. if•d rniLD <br /> VALUATION CALCULATION: Total $ /SOCA), a) 1,-) ►J t 0 to() h't (0'00/l-1 %_ <br /> Approved By: K.)6Ft5- ' t(G�Sfr,,d Date: Ejfrs�( i <br /> y s <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 /> ❑Site Work or Drainage Proposed <br /> Approved BV ),,,,,/t i� Date:C ///e/cr ❑Backflow Prevention for high hazard: <br /> (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 ❑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: ❑ A Separate PW Permit is Required (Permit#: PW ) <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 ❑ 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: aPublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL 5_/ o f -4" <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> Z <br />