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Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# Di-00 <br /> BUILDING 0PLANNING <br /> Intake OK by: Date: �4f 9 Intake OK by: (-- Date: —7 —2L Ici <br /> Intake Commen f Intake Comments: Assign To: • <br /> 11e0011 cuTeciiba req. - .,(Nce,,maci <br /> — � .ko r2J�,e.,..) -, care, (el, P <br /> e <br /> ❑ Route to Commercial Building 0 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 E,--j.M )(0 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use 1-p-. f }- <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: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? Yes Mo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate 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? DYes ❑ No ❑Everett School Dist ❑Mukiiteo Sch of Dist <br /> Add]RCW 64.55 docs required prior to final? ❑Yes ENo Additional Notes: A.,,, �� AS Ad_`PJ �QA) <br /> VALUATION CALCULATION: Total $ � <br /> / ' �' Approved By: C^'-'Hui Date: Jb-j—19 <br /> \ PUBLIC WORKS <br /> a <br /> Intake OK by: > � Date: �2 <br /> dditional Notes: Intake Comments: PW Worksheet Needed if. <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 2Yet i Si 7- J ' DSite Work or Drainage Proposed <br /> Approved By: yV Date: 14 /0%-t-- °, ❑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 /> ❑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: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> O Review of As-Built Plans- NO FIRE FEE AND 0 Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Q-Public Works has no scope---PW No Required <br /> Additional Notes. �j q (1.6 / )'-? <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> (7-7-4 <br />