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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT# 9 -\03-o(0 a <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 /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Ma a this a"W" Permit c* 0 OK to Route to Other Departments <br /> Bldg I/ ddn/Rem Size /') O6/ ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories per-> 2ar- Overlay/Agreement <br /> Basement 'No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction V` i,)t Residential Use <br /> Occupancy Group a`A-3 Proposed No.of Dwelling Units: <br /> Occupancy Load v2 it Total No.of Dwelling Units: <br /> Fire Sprinklers: Oupdate Existing El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes XNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Ivp Update Existing El 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? ❑ refYes ILJ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes I2No Additional Notes: �� <br /> VALUATION CALCULATION: Total$ i/4160l COO ® r'1(2, J`Zt5) U et" f <br /> Approved By: jL. Date: s— I b 'Zif <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if <br /> iD / bafr 10Sys Dev Eval XTraffic Mlt val <br /> • 9i i 'E ❑Site Work or Drainage Proposed <br /> Approved By: E Date: --�,�a/zi ' i . IoBackflow 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 /> rinklersAlarm ❑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: i,1-pate:j/—L -Z/ Igt,Public Works ha no scop -- Rimed Aff <br /> Additional Notes: ��// <br /> ELECTRICAL cs?n' _ W-6'1� lercfGs -friv <br /> Additional Notes:Approved By: Date: Approved By: jecA Date: 5r 2I12,01A <br /> ,/z <br />