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• 0 C rq G <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# I 0 ✓ 'a0( <br /> BUILDING PLANNING rr.. <br /> u <br /> Intake OK by: h' Date: 5737/ ! Intake OK by: 1 .., Date r z �"1 <br /> Intake Comments: Intake Comments: ev <br /> Assign To: : 1"�.� Cki \1 <br /> ❑ Route to Commercial Building ® Attach to Project No. NC\ \C\ — Ov-A <br /> -Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit © OK to Route to Other Departments <br /> Bldg/TtrAddn em Size / 3 06 .S ❑ Hold in Planning File Drawer <br /> Garage ccesso Struct. Size 'E— 1) Sag Zone �' `�,— 1 <br /> Number o Stories Z Overlay/Agreement <br /> Basement 'No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use SS(Z. <br /> Occupancy Group R Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: CVA. <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IN:INo <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 Idl No ❑Everett School Dist Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes I No Additional Notes: <br /> VALUATION CALCULATION: Total $ I C36t 7 7 <br /> l3 v6 @ l21 <br /> 32 3-0Approved B{ Date: ,2y,lchq <br /> 2c{2 ! 2S PUBLIC WORKS <br /> Intake OK by: - ` Date: t�S 7 0Additional Notes: Zo /5- /4C /,/S c. Intake Comments_ PW Worksheet Needed if: <br /> .,� l�Sys Dev Eval ❑Traffic Mit Eval <br /> Oa S�i /,386. e)-- CISite Work or Drainage Proposed <br /> Approved By: U/I - Date:7/�j'//9 NC `-"` 'IV/cn DBackflow 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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: • 0 This Permit is Approved by Public Works <br /> ftf I v ti JV he(a ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: A Separate PW Permit is Required (Permit#: PW /'1ov 'V ' ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Ols located in this folder <br /> ❑ Minimal or No Fire Scope- NO FIRE FEE [k 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 /> Approved By: Date: Approved By: X/ Date: e9g/kp7( <br />