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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#7 2%(76J'v(� <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 /> CI Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 120 ±4--1' 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone ,"Z <br /> Number of Stories 2 Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction \(— if7 Residential Use + ,46w: <br /> .%1) <br /> Occupancy Group -Z Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Chew System ®Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System WNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I'-i1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes isiNo Additional Notes: 51r _( vw e.av' ". tYik -" et) a. / <br /> VALUATION CALCULATION: Total$ 1 S� Wei.; or C g( ( or Qi '`'J/ <br /> lame, <br /> omk- <br /> Approved By: 1C.A Date: lr..11> <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 6l-llfughte R6''P�-Aeztvir-�T Intake Comments: PWWorksheetNeededif: <br /> CAI ` FR.LeZAK. or s-cNt.1/45UTOR . ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: ilia D <br /> (❑Backflow Prevention for high hazard: <br /> ll/l 1(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: OThis project also has a separate concurrent PW Review(Green Folder) <br /> DFire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ODeferred <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 /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> 121,Minimal or No Fire Scope-NO FIRE FEE ❑ 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(se.. _ - - _•- PW issued ahead of Bldg) <br /> Approved By: Ka Wn Date: 6;25 7G.2 Public Works has no scope --PW Not Required <br /> dditional Notes: <br /> ELECTRICAL <br /> Additional Notes: t+;. 10 I f' <br /> Approved By: Date: Approved By: 'f�C\ �`�t,11'.; 1 i, k Date: <br />