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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 2 I 65--,t5 — <br /> BUILDING PLANNING n E�/65 .- 3 <br /> Intake OK by: Date: Intake OK Assign To Date: -V1 <br /> Intake Comments: Intake Corn ents: <br /> l\)\V\\\\-Aa,S s Q , 4\.V\KUAn.'._eN t•kA <br /> w\ m.AW Q,Zr s'S S� \ - <br /> �,. � �� <br /> ❑ Route to Commercial Building ❑ Attach to Project No. RA.��k <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer -A,`A ' \' N S N^A'` <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone 'l "\.�'\ <br /> Number of Stories Overlay/Agreement `c ••y,�y'• -, r <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use �n0.Jf\ewe to ( ttNaL;\ <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: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Re ' ed before Final? ❑Yes Cho <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System El Not Req'd School Impact Fee: T $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No DEverett Sch I Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ElNo Additional N tes: <br /> VALUATION CALCULATION: Total$ `!o a D <br /> Approved By Date: ,\r, WZ` <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> / f j `Z CI Site Work or Drainage Proposed <br /> Approved By: / _ Date: / i❑Backflow Prevention for high hazard: <br /> /l�� <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 /> El Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> . <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 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(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: ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> ---Th, <br /> (e."-)12:2,, <br /> z <br />