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Ilk <br /> 6Atake &Approval Sheet 0 (FOR PERMIT STAFF 41AILY PERMIT# siskcI k\ "0 3 5 <br /> t BUILDING . <br /> PLANNING <br /> Intake OK by: , Date:• ti.0>cr' ,Intake OK by: (,11r) Assign To:TC C f t CC) Date: I) l22.Al <br /> Intake Comments: ;Intake Comments: <br /> El ��Route to Commercial Building Attach to Project No. r/ �1 6 -. (:) L-i <br /> V <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> El Make this a"W"Permit �.(OK to Route to Other Departments <br /> fi/Addn/Rem Size R'G S ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,v/4 Zane 6'Y\ —I <br /> Number of Stories / Overlay/Agreement <br /> Basement tlNo ❑Yes, Fin/Unfin Nonresidential Use 'Dra r1 S r+5 jj'J C k 1 <br /> Type of Construction I/5 Residential Use <br /> Occupancy Group At Proposed No.of Dwelling Units: <br /> Occupancy Load Oct Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System RNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes GlNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> ❑ ►r��v <br /> Fire Alarm: Update Existing ONew System 'LtNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes I1 No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ENNo Additional Notes: ----- <br /> VALUATION CALCULATION: Total$ /Z4 JZ�/,‘/ <br /> Approved Date: 171210�' <br /> PUBLIC WORKS <br /> Intake OK by: Date: JII 2 2---. <br /> Additional Notes: Intake Comments: =pW Worksheet Needed if: <br /> l Sys Dev Eval ?OTraffic Mit Eval <br /> ®Site Work or Drainage Proposed <br /> Approved B`'' ..,,, - Date:///z7� =OBackflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> VV ,, :supportive housing) <br /> FIRE DEPARTMENT IIIRoute 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 ❑Deferred <br /> Additional Notes: .This Permit is Approved by Public Works w <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 Goin 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 B , ate:l2 /( 2eI <br />