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0 !Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# /��" Ok.-t'62te <br /> BUILDING PLANNING <br /> Intake OK by: Date: 4 101 ►41 Intake OK by: ,1 Date: LA -1 ' )q <br /> --� � <br /> Intake Comments. Intake Comments: A sign To: <br /> e2.4(/( 41"911)- cr. <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size G/1- . p.Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone - 3- N LQ 1 <br /> �p <br /> Number of Stories Overlay/Agreement 4400 <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use Gl ct ck.) }v-vj— <br /> Type of Construction V Residential Use <br /> Occupancy Group U/I)-—T3 Proposed No. of Dwelling Units: <br /> Occupancy Load yl 1 AT Total No. of Dwelling Units: �{ <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 1L11No <br /> Reason Sprinklers Required: 0 "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑ 1tJi New System Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: r�Y Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes LJ No ❑Everett School Dist ❑Mukilteo School st <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑ lo Additional Notes: NvAon tts ,Iye. OVALUATION CALCULATION: Total$ l f a0`�(O° a �C�( (A <br /> Approved By: 4.-- Date: q hey <br /> LI' <br /> PUBLIC WORKS <br /> Intake OK by: g'f Date: 1 <br /> Additional Notes: Intake Comments: PWWorksh a Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> n y ❑Backflow Prevention for high hazard: <br /> Approved By: Date: J(�I nil 1 (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 ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 ❑ Is located in this folder <br /> Minimal or No Fire Scope-NO FIRE FEE 0 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: bL✓ 5/j✓'pate: la) / lmil 3 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: _.s D to Approved By: Date: <br /> 2 <br />