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Intake & Approval Sheet 10 (FOR PERMIT STAFF ONLY) 0 PERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI dd em ize <br />1309 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />2 <br />Basement <br />❑No 12Yes,n <br />Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System <br />❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System <br />❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes <br />No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes <br />No <br />VALUATION CALCULATION: Total $ .12A <br />///b OR 10-01SF pyN . 1?9.0 T ► %il 600 <br />1 cl 3 C 5-0 1 U fLr, . q 6 sm <br />L60 eat gAn^% 4Q0N CM D <br />5q• 5 i�1 1?A7A A(A7,0v -1%r1q <br />Additional Notes: Z®js- //_e !f ws <br />Approved By�.,� Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />.g <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by Assign To: Date: <br />Intake Comments: (� i <br />❑ Attach to Project No. <br />Route to Historic Reviewer <br />OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />04 1e -j- c5 <br />Proposed No. of Dwelling Units: <br />Z <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes MNo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 1T Z,j <br />Calculated: &T.4 I Z� Credit: <br />Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: Si,W)l 42r --H/0— <br />View L bedrOOVvi UvL+ I Vl (,,aSWeaf . NO <br />1-61wtI oom U (-j- e� JSfiyL. <br />Approved By: Date: 2 0 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />............ <br />Intake Comments: PW Worksheet Needed if., <br />I <br />![]Sys Dev Eval ❑Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />(supportive housing) <br />} <br />❑ Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />0-see PW Review Worksheet and associated attached items <br />[-A Separate PW Permit is Required (Permit #: PW T oO 0$4 ) <br />AND glk located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ WIII be Issued separately (separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved B Date: b $ l 9 12o2a <br />