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Intake &Approval Sheet 4111(FOR PERMIT STAFF ONLY) • PERMIT# C(1 D 3'610( <br /> BUILDING' PLANNING <br /> Intake OK by: (3 I( Date: 3'/( ( (1 Intake OK by: 10 Date: (1, / 1.1 <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> jEtRoute 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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 4o0 sr Zone 12— <br /> Number of Stories ( Overlay/Agreement kf , <br /> Basement 12.No ❑Yes , Fin/Unfin Nonresidential Use V A-- <br /> Type of Construction Residential Use 1/"-- <br /> Occupancy Group Proposed No. of Dwelling Units: 00 y.-tj vr.n -j <br /> Occupancy Load Total No. of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IIV.o <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System El Not Req'd School Impact Fee: Total $ life— <br /> Reason <br /> Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes JZ No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes No Additional Notes: <br /> VALUATION CALCULATION: Total$ '7 Z0ro <br /> Approved By: ivrDate: C tit/ <br /> PUBLIC WORKS <br /> Intake OK by: �'7 Date: <br /> 31 <br /> Additional Notes: •2©/s /PC Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Qj(' Date: E////4/ ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT IPRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: . r.tThis 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: 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: hilaiz0,9 <br />