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0 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2k-°3 '050 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:l� Assign To: rNt)f:J 1 ' Date: 5/I1/72_I <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ R• to to Historic Reviewer <br /> ❑ Make this a"W" Permit 114 •K to Route to Other Departments <br /> Bld I/. n/Rem Size 1a,C,00 #t'/1 In Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size IlitV7 it 4 Zone (:1-2.-- <br /> Number of Stories / Overlay/Agreement <br /> Basement ilNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction —.5 Residential Use <br /> Occupancy Group i3/�% Proposed No.of Dwelling Units: <br /> Occupancy Load f/04 Total No.of Dwelling Units: <br /> Fire Sprinklers:,(aUpdate 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: 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 Al No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'RCW 64.55 docs required prior to final? ❑Yes 1ZliNo Additional Notes: <br /> VALUATION CALCULATION: Total$/35;QCC,04" <br /> Q,t/` erkwib I <br /> Approved By: \ e,S Date: i.i _.'I '�a-'l <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> q ❑Sys Dev Eval ❑Traffic Mit Eval <br /> �,' A. (9 ,ei fd:-j ❑Site Work or Drainage Proposed <br /> Approved B Date: ( J//� t ❑Backflow 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: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This 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 0 Is located in this folder <br /> .r❑ Minimal or No Fire Scope-NO FIRE FEE CI Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 121 Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By tee:3 3d:Z/ ta,,Public Works has no scope---PW Not Required <br /> L/—()-,?I Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> i <br /> Approved By: Date: Approved By: Av <br /> 0; Date: ` i, <br />