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0 40 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Q\Ct OA—cog <br /> BUILDING PLANNING <br /> Intake OK by: 'clit' Date: 4/i 7l11 Intake OK 1` Date: 4t/(}'1 1 <br /> Intake Comments: Intake Comments: Assign To:1ll1 i- vve t.G(Q <br /> Ln ro, v J <br /> aRoute to Commercial Building ❑ Attach to Project No. <br /> Route to Residential Building 0 Route to Historic Reviewer <br /> El ! 'l/3o/I <br /> Make this a"W"Permit I.� OK to Route to Other Departments j3 4 I <br /> Bldg/TI/Addn/Rem Size 2Z 14 I Hold in PlanningtFile Drawer <br /> aarag Accessory Struct.Size 0-0Z.- •S."rf Zone R-S <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Mes, in Unfin Nonresidential Use ------ <br /> Type of Construction 'E5 Residential Use 'jt''—( __. <br /> Occupancy Group 1g tiL Proposed No. of Dwelling Units: <br /> ___________ <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: OUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes EN--; <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 f No ❑Everett School Dist ❑Mukilteo School Dist / <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes Ilo Additional Notes: ----* �,p� (yam/ <br /> VALUATION CALCULATION: Total$_ 167 45( `4/ OSC °J <br /> Approved B Date: 1.I3ohq <br /> PUBLIC WORKS <br /> Intake OK by: i Date: 4 f I- fro,/ <br /> Additional Notes: Lots- gC.. pof_ Intake Comments: PW Worksheet Needed if: <br /> ro �s <br /> ..IN<_W Fs-T-rAcimE: 1-IA a.A6ria La sSys Dev Eval ❑Traffic Mit Eval <br /> AA-VD R E.to c.c_t> P,Site Work or Drainage Proposed <br /> �`�=`�""4'-r ❑Backflow Prevention for high hazard: <br /> Approved By: Date: 5�3(/(9 —1(ev2 5 14 %4J (ttt'V.Acto <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT toute 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: Ig his Permit is Approved by Public Works <br /> ZSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 8-A Separate,y PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Lis located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date:(Q ( -, <br /> 7 <br />