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41110 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# kCt©J zog <br /> BUILDING PLANNING Intake OK by ,7_ Date: a�Z/2-4/ Intake OK by:C I Date: l Q 1 <br /> Intake Comments: Intake Comments: Assign To: \e,\S <br /> ro su,d' rr Z.d Dtic SeT" d G4« >0**41 <br /> 2Aet• t 0 l->n1 n <br /> III Attach to ProjectZPU V"1 Fo <br /> y' -v' t`�- <br /> SEX- <br /> El Route to Commercial Building No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 2.1 OK to Route to Other Departments <br /> BldglTl/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone -3 <br /> Number of Stories Overlay/Agreement (' <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use .vet &&� <br /> Type of Construction Residential Use 0/4— <br /> Occupancy Group Proposed No. of Dwelling Units: V <br /> Occupancy Load Total No.of Dwelling Units: Iv <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? Wes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑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? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: ti4 ( - S <br /> VALUATION CALCULATION: Total$ yvl' GoK) A Lc,Ks- (3(14)' "vim/ <br /> yli 4t N g< b7svic.7c 131~'(7-Lrt--TE_ ( f N)►��`" <br /> Approved By: khr-A.c"-- Date:k( <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: %ii Date: 11.44-pq ❑Backflow 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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ 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 ❑ Is located in this folder <br /> 0 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: 'ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> �3A2y�G�9 <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2/L <br />