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• <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# war Do\ <br /> BUILDING PLANNING <br /> i <br /> Intake OK by: A�<<i Date: Intake OK by: Assign To: WWI Date: <br /> Intake Commen ill Intake Comments: <br /> rG{_.LOw —WF wf V i4 ' G-Frc <br /> A4a6(41- 'reRm..-rr'i.rzv <br /> -1,fv7'D Ivrx.c-H'L.- 1 v,IPO 'r k-re-I c,-rt tart. <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 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 V <br /> CZ- <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 5 .. i4 iitino, OLG. <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: I <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes'No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System CI 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 0 No ❑Everett School Dist ❑Mukilteo School)Dist <br /> Add'I RCW 64.55 doss required prior to final? ❑Yes ❑No Additional Notes: .2, ,D 511116 (�2qed oil-S5�C.; <br /> VALUATION CALCULATION: Total$ v ujeik- a1"�C I L 4 1.01O <br /> ce VCa '47 <br /> �Ge {' + a j <br /> Approved By: ` A Date: 1 Za li. i <br /> 9 <br /> P BLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: J Date: '02--)o2.b(t et I❑Backflow Prevention for high hazard: <br /> /I' / :(dental,medical,animals,mortuary,hospital, <br /> l J ;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 /> 'x: <br /> Additional Notes: El 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 0 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: VI Public Works has no scope PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 42_ <br />