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• �tt`\Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ?l q1 —OSZ <br /> BUILDING PLANNING <br /> Intake OK by:O,,4 Date:/22.D/e' Intake OK by: Assign To:Te(-e C Gi Date: I) /Zz/i I <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building SC1 Attach to Project No. "09 R I L 0"9- <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit coOK to Route to Other Departments <br /> IP fl/Addn/Rem Size 4,3Z- 5,F ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size , //,Q Zone rn—{� <br /> Number of Stories / Overlay/Agreement <br /> Basement a`Noo ❑Yes, Fin/Unfin Nonresidential Use IY(afl Sr+S-f2-H '1 <br /> Type of Construction V A Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load O 419 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: Amount$ <br /> Fire Alarm: El 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 El No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes lEiNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 3 I <br /> Approved B Date: J 2, 2)VI 11 <br /> PUBLIC WORKS <br /> Intake OK by: Y 3-% Date: <br /> Additional Notes: Intake Comments: PW Worksheet eeded if: <br /> aSys Dev Eval ?OTraffic Mit Eval <br /> I IOSite Work or Drainage Proposed t_ <br /> Approved Bk.h..^ Lv Date: //i�/7„,o of OBackflow 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: E This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND MICreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: his 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 /> ❑ 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: �'41---B•gte: 424 Izoa <br />