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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ON09 <br />• <br />PERMIT # �E) 2CO 2 J --Q 2-2-� <br />BUILDING <br />Intake OK by• `�i Date:ZOZ-6; <br />Intake Comments: <br />>GM i-c A(Vr ;d to LCS . <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />/17„-� <br />Number of Stories <br />I <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />V6 <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System [3Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing 0New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? []Yes ❑ No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes C3 No <br />VALUATION CALCULATION: Total ,S 6 r ���, 64-7 <br />Additional Notes: <br />Approved � � ; Date: 0,�� <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers WireAlarm El Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />kReview / Inspection Scope - ADD FIRE FEE <br />Approved By: <br />Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />N <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes o <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />[]Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: lei C (A` "rc�xnt) ao 0 <br />4)1 . 11 Co I Z.. a <br />Approved By: Date: Z <br />PUBLIC WORKS <br />Intake OK bin . N Date: 2 ! C-z- <br />Intake Comments: PW Worksheet Needed if., <br />S s bev Eval ,�•�,{� raja•- it -EVaI <br />y WTraffic Mit Eval <br />332C7 5F IElSite Work or Drainage Proposed <br />s <br />�}�C 4�.►T :o SU�.�. 10Backflow Prevention for high hazard: <br />x 1(dental, medical, animals, mortuary, hospital, <br />(supportive housing) <br />nRoute this folder for PW Review at end ... -..... PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously El Deferred <br />This Permit is Approved by Public Works <br />QSee PW Review Worksheet and associated attached items <br />-A Separate PW Permit is Required (Permit #: PW Zc>e S h C+ ) <br />AND n1s located in this folder \*4 a-. . " dZt <br />❑ Is in a Separate Green Folder (join with this folderfor permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved Byr Date: ` <br />