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210 <br /> Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# '2•l 0 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To:J t/ b Date: I?i/ <br /> Intake Comments: Intake Commerts: / <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 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size s k/, 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone Vv Y" 0 <br /> Number of Stories Overlay/Agreement `""" <br /> Basement ❑No ❑Ye , Fin/Unfin Nonresidential Use !KI I. 1-I-P al`eVutvl <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existin. i 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 rxisting ❑New System ❑Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Rey ired: Calculated: Credit: <br /> RCW 64.55 MF work eet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55..cs required prior to final? ❑1Yes ❑No Additional Notes: <br /> //VALUATION CALCULATION: Total$ / , <��a eY NO SLVICt — al( ior' <br /> Approved By: 06 Date: 3/i 2p.„02-1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Adylti `llot c� 1 /46 bah'(' Intake Comments: 1PW Worksheet Needed if: <br /> °(�' l ""� • 57 T* bitb,r c l C., OSys Dev Eval ❑Traffic Mit Eval <br /> II Ex-1771.5 leA(14 434 !Mite Work or Drainage Proposed <br /> Approved By: 7—"te Date: G131' 14-- I DBackflow Prevention for high hazard: <br /> ((dental,medical,animals,mortuary,hospital, <br /> tiljalZ/ isupportive 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 /> ❑ 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 /> Ei 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:4 Date: Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2/7/ <br />