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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) 110 PERMIT# Q` `O - -COZ <br /> UILDING �j PLANNING <br /> Intake OK y: Date: r1 - 3 ` C-t Intake OK by: (/t Date: —7 / 3 ) <br /> Intake Comi Terris. Intake Comments: Assign To: <br /> D Route to Commercial Building ❑ Attach to Project No. <br /> pRoute to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit OK to Route to Other Departments <br /> Bldg/Tld /Rem Size Ca 5 Z S/ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size &S Z S,F Zone 2-2. <br /> Number of Stories Z Overlay/Agreement <br /> Basement WNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction V 15 Residential Use S{"12— <br /> Occupancy Group elci` Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Re red before Final? DYes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ONew 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? DYes 14 No DEverett School ist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes INo Additional N s: <br /> VALUATION CALCULATION: Total$ j!zf3t¢t£3. 7 <br /> 6S2 @ l2) I07,091. <br /> 8 5 Z. c l 3 qc, (ail.. Approved By: Date: (,,) <br /> PUBLIC WORKS <br /> Intake OK by: i 4.3 Date: 7 .,.5 r : of <br /> Additional Notes: Z 0 <s" /e.1' it, 1,0S6C. Intake Comments: PW Worksheet Needed if. <br /> eJf. s A�-r'Acat Ia Sys Dev Eval ❑Traffic Mit Eval <br /> F,Aa..e.c..E ^' eaSZ Pi ( Site Work or Drainage Proposed <br /> ",E-� '? .d C cs a ..i E�'� DBackflow Prevention for high hazard: <br /> Approved By: Date: 7 ' Cj ni 10 6 <br /> (dental,medical,animals,mortuary,hospital, <br /> ?Cob s G -rb AL.. supportive housing) <br /> FIRE DEPARTMENT EIRoute 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 CI Other: AND ❑Create Green Folder ❑Submitted Previously DDeferred <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,A Separate PW Permit is Required (Permit#: PW t1 b� o3Z ' , <br /> O Review of As-Built Plans- NO FIRE FEE AND ,❑)s located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE F Is in a Separate Green Folder(join with this folder for p2 issuance) <br /> O 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.c; di Date: (J/ / 43 1, //may <br /> -(-Z <br />