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• <br /> • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2b 1'621 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by. (° Assign To 37"4J R Date r 1 <br /> Intake Comments: Intake Comments: 1 <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size .2, 8 4--2 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone cV1—,VIA <br /> Number of Stories 1 Overlay/Agreement <br /> Basement No ❑Yes, Fin/Unfin Nonresidential Use _ <br /> Type of Construction _ '�'�- a, Residential Use <br /> Occupancy Group 'T Proposed No. of Dwelling Units: <br /> Occupancy Load It - Total No.of Dwelling Units: <br /> Fire Sprinklers: OclUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers <br /> 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 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes L"JNo Additional Notes: p J\IU? (a �di v 1 ,( <br /> VALUATION CALCULATION: Total$ 4-0o� ��� � N o a6 cka� �'`� . <br /> � <br /> Approved By: Date: I I /f 1 /249 <br /> PUBLIC-WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: !PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: _/?2J2..o2J (]Backflow Prevention for high hazard: <br /> 1(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ire 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: ❑A Separate PW Permit is Required(Permit#: PW <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is 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: k,?)r`o(.J`fl Date: 12—1-;,20„26 jr, blic Works has no scope---PW Not Required <br /> dditional Notes. / <br /> ELECTRICAL f/ rGS1.+ <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />