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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#�` ``k <br /> BUILDING PLANNING <br /> Intake OK by: Date: 1 ' `.Gi Intake OK by: Assign To: Date: <br /> Intake Comme s fff 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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 231,2 -r4- 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone ' 2 <br /> Number of Stories 't Overlay/Agreement <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use \Cl,)0 ,,.4\l V 1I C <br /> Type of Construction Vl; Residential Use ff--- <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 3g Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System 11Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IZ]No <br /> Reason Sprinklers Required: Na 1,61.E To 41t4Ire�. "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ®Update Existing El 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 RI No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $ (es�t <br /> Approved By: Date: \\_ \(A Z j 9 <br /> 1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: I t I t3 I z-.t 9 <br /> Additional Notes: Intake Comments: '"rHq.,z„ 'PW WorksheetNeededif <br /> yy��r1E a=• :• . ? <br /> t 'T I,4Sys Dev Eval LsrTraffic Mit Eval <br /> El Site Work or Drainage Proposed <br /> C('- - ILA Cyivo - ' <br /> Approved By: Date: 2 2 I S;ti z-c :a i❑Backflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary,hospital, <br /> r�oEs •tor _e;twv.t�l.�, ►.1:4A upportivehousing) <br /> Cn. E S e............................................................................................................................................................ <br /> FIRE DEPARTMENT FRoute 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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred <br /> Additional Notes: 04his 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Ia Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K.A3v-ocA y Date: ) ) -fct ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: /1tC i p 6:m464.4.45 <br /> ELECTRICAL iJA C& "4. -r4CR pE.L.r EA ' ,S3. jra <br /> Additional Notes: <br /> Approved By: Date: Approved By. - -- Date: _ / /1 z <br /> 4 <br />