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11111 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# k02--{O`A <br /> BUILDING ; PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <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/Accessory Struct.Size Zone LI. 'l <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No . es , Fin/Unfin Nonresidential Use t„J:'Pt>'2t5 'n ( 46 s\Nl3) <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: ❑U..ate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 15fNo <br /> Reason Sprinkle Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd_ School Impact Fee: Total $ <br /> Reason re Alarm Required: Calculated: Credit: <br /> RCW .4.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo Scho ist <br /> Add'I RCW 64.55 docs required prior to final? Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $ `7 C de7C-/ <br /> Approved By: ILA Date: Z. )Z Zi <br /> PUBLIC WORKS <br /> ,./6(.1 <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> J ❑Site Work or Drainage Proposed <br /> Approved By:G., Date: /�3 /OZ/ €❑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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder OSubmitted 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 0 Is located in this folder <br /> ❑ 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 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> (515-f. 'off <br /> Approved By: Date: Approved By: jet, ate: Z' <br /> `2 t <br />