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• <br /> ill <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ficle:A-65—. <br /> 3 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:0 Assign To: X Date: 12/24/(9 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> BldLddn/Rem Size 1065 5'f ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone & L WI ✓a/Q <br /> Number of Stories 2 Overlay/Agreement <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction 1,44 Residential Use <br /> Occupancy Group ' Proposed No.of Dwelling Units: <br /> Occupancy Load /0 (TS 5.040 Total No.of Dwelling Units: / <br /> Fire Sprinklers: Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes Edo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: .Update Existing El 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? DYes ,® No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add.]RCW 64.55 docs required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total$ S3?020L" " 1 vi+e-r11 or W oif/-- . <br /> Approved By:a/r6 Date 0 I /GIl2/20 <br /> PUBLIC WORKS <br /> Intake OK by: _fl-.t Date: i12l f 202o <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> 8.4-r42-4-'0 12"E-"°`' -`- I❑Sys Dev Eval ❑Traffic Mit Eval <br /> El Site Work or Drainage Proposed <br /> Approved By( Date: OVZYyOZp I❑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 /> El Fire Sprinklers ❑Fire Alarm DOther: AND ❑Create 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 ❑ 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: OPeblic Works has no scoop- --PW Not Re uiri d <br /> Additional Not -' i lZ/ r2c.r .) <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: h/ <br /> y/v <br />