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0111 <br /> (})q <br /> Intake &Approval Sheet 1110 (FOR PERMIT STAFF ONLY) PERMIT# A39--00?-'-' <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 — w Zone '8•Z <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use finOnuai Itioti` tiy. <br /> Type of Construction VT%2 Residential Use <br /> Occupancy Group U Proposed No.of Dwelling Units: <br /> Occupancy Load - Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System FA Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes'giNo <br /> Reason Sprinklers Required: / "In Lieu"Fee:Type: Amount$ <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 ,1�{I, No ❑Everett School Dist ❑Mukilteo School Dist <br /> ❑ LI <br /> Add'I RCW 64.55 docs required prior to final? Yes No Additional Notes: , Ma,* w+1$43 t I N C./ Ic.39Ano <br /> VALUATION CALCULATION: Total$ 2, o' 0A6, SN(.14.34•to• JJ <br /> Approved By: 1L,`1c.211, Date: q t _ZOZo <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Po. '154.s-Es roe HG i Intake Comments: PW Worksheet Needed if: <br /> 4-a U Po_ ' No c-y-0+-ttyt.- IOSys Dev Eval OTraffic Mit Eval <br /> vim "' €Mite Work or Drainage Proposed <br /> Approved By: Date: -�,21��s� OBackflow Prevention for high hazard: <br /> 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 /> ❑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 /> ❑ 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: Date: ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By17.,�� Date: 04/0 SiIZo� <br /> v`z <br />