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• <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# ?« O "0 CZ <br /> BUILDING PLANNING <br /> r-- <br /> Intake OK by */l, Date:O/dS Zo/7 Intake OK by: Date: C\•CYJ- <br /> Intake Comments: / Intake Comments: Assign To: 0\ <br /> \aci2A14.A. VA <br /> '"C <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 5 0 Hold in Planning.File Drawer <br /> Garage/Accessory Struct. Size — Zone , <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ... <br /> ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction .J —-? Residential Use <br /> Occupancy Group '4 ;' Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: pUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspecti Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: OUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Tot $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No DEverett School Dist ❑Mukilteo School Dist �,� <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes WNo Additionalal Notes: ta 6, -\c,� ()J IJJ�ai� `\Q\ <br /> VALUATION CALCULATION: Total $ "1�t -A-Loq <.,, �-ri�\A© VoVI\�S ,‘AV\ S \\ <br /> cA\sQ �P ri:T- <br /> ir\ 'SC%s 2Akk ez-� <br /> Approved By: Date: O C) "_ Q <br /> a <br /> PUBLIC WORKS <br /> Intake OK by: 7-1-1 Date: `t t5/ZO I g <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 1-2-00.F-rc ? \No(Z.� �� ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: <br /> I (R ti1a -- Nr.t Sw:0 ❑Backflow Prevention for high hazard: <br /> r Date: �l1"[ (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 /> ❑Fire Sprinklers ❑Fire Alarm ['Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 110 Y'C u IA 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-Bui fans- NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or ire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Revie nspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> App ed By: Date: Public Works has no scope---PW Not Requir <br /> Additional Notes:-- c71S' t 9 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 0 <br />