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DS -0 7 ( <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# - <br /> BUILDING PLANNING' <br /> Intake OK by: Date: Intake OK by:O"12 Assign To:In 2 Dater- -2 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Ute to Historic Reviewer <br /> ❑ Make this a"W" Permit OK to Route to Other Departments <br /> Bld /fl/ ddn/Rem Size 6✓ ✓061:f ,PC—/'L.d!'E Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone ,U 1" <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use `/u,v i ii -1GGt11,I I <br /> • <br /> Occupancy Group /47-; Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? gYes 1❑INo DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑ rcy Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ f 7 e3. SI <br /> 7 <br /> Approved By 1 Date: ,2 76.2 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> !Mite Work or Drainage Proposed <br /> Approved B . " ,.,_ _ Date fe,Z/ =❑Backflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT El 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 /> El Fire Sprinklers Cl Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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: '\4,65--e2tAAN Date: 5 y;._ 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />