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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �2-CDS —O4IQ <br /> BUILDING PLANNING ' ' <br /> Intake OK by: Date: Intake OK by: of:-.) Assign To:171(.Q 110 Dater I S- -I <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> El Make this a"W"Permit ,JOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 99'6 0 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,VL2 Zone liy <br /> Number of Stories / Overlay/Agreement <br /> Basement igNo ❑Yes, Fin/Unfin Nonresidential Use g0e4Y\6 <br /> Type of Construction (i 6 Residential Use U <br /> Occupancy Group L7 Proposed No.of Dwelling Units: <br /> Occupancy Load -7 Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System NINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System 41.Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes , No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes .13No Additional Notes: <br /> VALUATION CALCULATION: Total $ 'ii Oo O�% <br /> Approved By:/ Date IS 762+ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed If: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved „iIti, Datez�//g/ l❑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 ❑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 /> Er Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Kgcce,tin Date: S_' Public Works has no scope---PW Not Required <br /> Additional Notes: - a 7 I (4 I 2- f <br /> ELECTRICAL <br /> � <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />