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0 0 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# B 210 5— 0 31 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:/ Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> BldglTl/Addn/Rem Size ElHold in Planning File Drawer <br /> Garage/Accessory Struct.Size /; Zone P-2 <br /> Number of Stories p�`"� F(c� Overlay/Agreement �U GU(,►R.W177 +\iS-IoriC <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction P2-C— Residential Use 5 r <br /> Occupancy Group cly'-C- Proposed No.of Dwelling Units: <br /> Occupancy LoadrL--- Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System VNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: ,�j "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System L_iNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Ef No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes 121No Additional Notes: <br /> VALUATION Total ' i �'' 6� <br /> so <br /> �� Approved By: � <br /> Date: � <br /> if <br /> PUBLIC WORKS <br /> 7aQ Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ibarti' Ce12-52-14 <br /> ; Sys Dev Eval ❑Traffic Mit Eval <br /> =OSite Work or Drainage Proposed <br /> � =DBackflow Prevention for high hazard: <br /> Approved By: ���d.S Date: / 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 I 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: ❑A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 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 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: lublic Works has no scope---PW Not Required <br /> Additional Notes: ,,.{,o ,i.tc,,4 rk prude, Iva.,Ac.E_ AO-CA, <br /> ELECTRICAL <br /> Additional Notes: 0 5 f 2(l20 2! <br /> Approved By: Date: Approved By: Date: <br /> 2- <br />