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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# Vie 1 ` k0 03 2 <br /> BUILDING PLANNING <br /> Intake OK by: Date: (072i% Intake OK b( Assign To: ,e e Date:\ 1D, - 9 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> 151 Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/ cccess Struct.Size 2 9 0 Zone �JJ \, id - 1 , • _ <br /> Number of Stories I Overlay/Agreement 1 IV CQf t1��` \l'Strl j C U . <br /> Basement tallo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction ,17$ Residential Use c K <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: C:Nett <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: CI 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? rd es kl No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final. ■YYes El Additional Notes: <br /> VALUATION CALCULATION: Total = S7co <br /> \Z.---2 Approved B Date: 3 C, Z MCI_ <br /> PUBLIC WORKS <br /> Intake OK by: 7-4-1 Date: I C*[2.I I I et <br /> Additional Notes: 20/S a2L c Intake Comments: PW Worksheet Needed if: <br /> £ '( S' ❑INviCov"�t> . [c = Sys Dev Eval Tra cat Eval <br /> dl`o'D 5'74. a 5f4 +`ate-1-- Site Work or Drainage Proposed <br /> s --re --t.Loy -Pic.rr.,.►,-r <br /> Approved By: Date: /Z//Z el en L =OBackflow Prevention for high hazard: <br /> 1� :(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT URoute 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 El Deferred <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 Pla's-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire :cope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspec'sn Scope-ADD FIRE FEE ❑ Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: / Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By� Date: f( (2 7 /20 i9 <br /> 2/Z <br />