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4111 <br /> Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) PERMIT# 60iI -61 (9 . <br /> LDING + PLANNING <br /> Intake OK by: Date: I I J '� 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 ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.-Size Zone I l— II <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use PePS; to <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El 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? ❑Yes 0 No DEverett School Dist ❑Mukilteo School Dist �, c,Add'I RCW 64.55 docs required prior to final? ❑Yes ❑ �No Additional Notes: (j' ;A bt}1,(11 5ei xc - <br /> / <br /> VALUATION CALCULATION: Total$ LY--Z r e k-c. feAke,,�c or pip p pi 9 r V+ OI- <br /> -r1h=5 od, --- t�Y� h r0 rtic <br /> _ Approved By: It- Date: " 1(— 2Z_)9 <br /> V <br /> PUBLIC WORKS <br /> Intake OK by: -`C 4- Date: I t 1 IA( l 1 <br /> Additional Note R u -1- t, -11:+2-ovEM --11+/ Intake Comments: i PW Worksheet Needed if; <br /> `OSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> i / �"i`p '0 i. we�iL €❑Backflow Prevention for high hazard: <br /> Approved By: Date: 1 `1 :(dental,medical,animals,mortuary,hospital, <br /> ..Ao 7.r-% S c.o(,fz <br /> :supportive housing) <br /> DEPARTMENT DRoute this folder for PW Review at end --PW Review Worksheet <br /> Separate/Deferred Su•mittals 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder Qoin 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: la 'ublic Works has no sco Not Re uir ' <br /> Additional Notes>j <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2, <br />