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f- :2_\0(4 -0 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# `u <br /> BUILDING PLANNING: <br /> Intake OK by: Date: Intake OK by:k Assign To: riIfJZ-. Date: `-/`;/ 1 <br /> Intake Comments: Intake Comments: cO.C.e , <br /> ❑ Route to Commercial Building attach to Project No. �� `���-i=\a — )1Al.__ <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ElMake this a"W" Permit pi/OK to Route to Other Departments <br /> Bld /TI/ do/Rem Size i , [0 EE ElHold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories / Qvorlay/Agrccr cnt I S� e k, RoXfoyynk.r•AzxA-C�4ryQC�c <br /> Basement �No ❑Yes, Fin/Unfin Nonresidential Usef1-e-ii}Is 0-f1\I(C. <br /> Type of Construction V:—la Residential Use <br /> Occupancy Group I-) Proposed No.of Dwelling Units: <br /> Occupancy Load `;� Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System'ONot Req'd Planning/Landscape Inspection Required before Fin ? Yes, ONo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System niNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ur No El Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes 12No Additional Notes: <br /> VALUATION CALCULATION: Total $ eZ.,(/O" <br /> Approved _ Date: 2•"-A._-zcy� <br /> PUBLIC WORKS <br /> Intake OK by: , 1/X3 Date.'.............5/'S7.u�2(..........,..., <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> SF.-NO1Sf /O , bigg %Sys Dev Eval liTraffic Mit Eval <br /> '1 tzoi l,f 8= s'F EISite Work or Drainage Proposed <br /> Approved By: Date: �' it �Backflow Prevention for high hazard: <br /> ' �� / / I •j` ��u" ! 1(dental,medical,animals,mortuary,hospital, <br /> per• ;supportroehousing) <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 DOther: AN ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> Kisee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: A Separate PW Permit is Required (Permit#: PWcIOS"091 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 'Is located in this folder <br /> linimal 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:4tf -ip( I(_ Date: 3/ I4l / 1 0 Public Works has no scope---PW Not Required <br /> Additional Notes: S D it T - mit <br /> ELECTRICAL ct � /twiliL_ f_ raft- a-'L M <br /> Additional Notes: f lA - 'P&j PE. ,in CI- I' ird <br /> Approved By: :3 Dater /;,� /,,,, Approved By: - Date::_ 5/9I/O. .l <br />