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0 • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#rE«t0 -() 2C <br /> BUILDING PLANNING <br /> Date: k7 ill-1 ! Intake OK b Assi n To: �V�'t� Date:\O . 1 <br /> Intake OK by: `��� - �' y(; �`� 9 � A . <br /> Intake Comments: Intake Comments: 43'C <br /> ❑ Route to Commercial Building S-Attach to Project No. 6 ^ 0:(2)0 <br /> Et Route to Residential Building ❑l Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 1t OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size i.D . ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size u. L Se s Zone - c`-. \ <br /> Number of Stories 1 Overlay/Agreement KV A" <br /> Basement INo ❑Yes , Fin/Unfin Nonresidential Use '1\) /AV— <br /> Type of Construction Z Residential Use STC <br /> Occupancy Group u Proposed No.of Dwelling Units: t tr.ricu jar /6' <br /> Occupancy Load IV/ Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ['Update Existing ❑ ®.New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yeslo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System Not Req'd School Impact Fee: Total $ KJ/A <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Eallo El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ Z?t o40 <br /> Approved By: (kvt (‘ ► • /te te: I'• IA. O 11 <br /> PUBLIC WORKS <br /> Intake OK by: -r"J Date: t O l 14-1 1 5 <br /> Additional Notes: 2O i 5- I g� Intake Comments: 1PW Worksheet Needed if: <br /> S.ys-Uev Eval ❑Traffic Mit Eval <br /> 6-46t-z pr"&" I RStte Work or Drainage Proposed <br /> pp y /j,' j "'' 6aUO SF €DBackflow Prevention for high hazard: <br /> Approved B Date: i <br /> I(dental,medical,animals,mortuary,hospital, <br /> 'supportive housing) <br /> FIRE DEPARTMENT L lRoute 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 /> Additional Notes: r i This Permit is Approved by Public Works <br /> e 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 /> ❑ 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 0 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: Sure wocr.e. u niv C 2 4ePereaCr> <br /> ELECTRICAL a'W 19cS-o3 G. <br /> .---2) <br /> Additional Notes: <br /> Approved By: Date: Approved B . Date: QI (I& Iii <br />