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Intake &Approval Sheet 4110 (FOR PERMIT STAFF ONLY) • PERMIT#61.008_ 6z6 . <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: g Assign To: Date:6/24 Intake Comments: Intake Comments: /iz <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route 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 1.0"'' -❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone ---/, <br /> Number of Stories gkc) Overlay/Agreement O&f / V�I I4er' %i <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction ri2-e— Residential Use 5f-V <br /> Occupancy Group t Proposed No.of Dwelling Units: <br /> Occupancy Load AA Total No.of Dwelling Units: �( <br /> Fire Sprinklers: ❑Update Existing ❑New System ''Not Req'd Planning/Landscape Inspection Required .- ore Final? ❑Yes L�INo <br /> Reason Sprinklers Required: rrzz "In Lieu"Fee:Type: Amount$ J <br /> Fire Alarm: DUpdate Existing ❑New System E((Not Req'd Schoo - -e: Tota :. <br /> Reason Fire Alarm Required: ,,( Calculated: _-' • <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes -"CI No ❑EverettSc►.ol Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes Ntl No Additional Notes: NO aka ra -1-0 <br /> VALUATION CALCULATION: Total$ aeri(f cr1ex {01 her I-c retwr isO0dl-rtge,4G, because,All info, Wof <br /> Approved By: Date: I7'(.of2P <br /> "" YY PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> Approved By:61,25' Date:icP /41/,2/ ❑Backflow Prevention for high hazard: <br /> 6 i(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 /> DFire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder coin with this folder for permit issuance) <br /> El Review/Inspection Scope-ADD FIRE FEE D Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: I. <br /> ' blicW Works has no scope---P Not Required <br /> • <br /> additional Notes: <br /> ELECTRICAL q/tZ Iz-24S <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />