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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 7(R O 3 o?.q <br /> BUILDING PLANNING <br /> Intake OK by: Date: 3 /Zti/19 Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building ❑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 ❑ Hold in Planning File Drawer <br /> Garage/ ccesso truct.Size �h9 Zone R --- <br /> Number <br /> of tortes t Overlay/Agreement <br /> Basement KNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction `T3 Residential Use S Z <br /> Occupancy Group U. Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IKI.No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: n $ <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 I�cNo ❑Everett Scho ist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 7lo Additions otes: <br /> VALUATION CALCULATION: Total$ I1i-t9 <br /> t SK 11 Cau• $b (.4g .5g10 <br /> -2:2-x(1 E 2-r2 to$o Approved By' _s - Date: 'ZZ 0 9 <br /> PUBLIC WORKS <br /> Intake OK by: G Date: 'f!Z 7--- <br /> Additional Notes: 2_pis' `,L Intake Comments: PW Worksheet Needed if: <br /> Z.J:4. ) ❑Sys Dev Eval ❑Traffic Mit Eval <br /> B". •o,..- A.— l Site Work or Drainage Proposed <br /> Approved By: Date: /�� ,9 J ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ORoute 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 El Fire Alarm ❑ er: 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-B t Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or o Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Revie Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELERICAL <br /> Additional Notes: G � <br /> Approved By: Date: Approved Date: j/Z4/20/9 <br />