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• • <br /> 050 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ? , .'`o r <br /> _ �l BUILDING PLANNING' <br /> Intake OK b �./'1, Date: d?/Z-3/� 1 Intake OK by: Assign To: Date: <br /> Intake Comments: / Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ - this a"W" Permit ❑ OK to Route to Other Departments <br /> Bl:g/TI/ ddn/Rem Size ` TICS" 6/ Tr. ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size —" Zone <br /> Number of Stories 1.4.1 b Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use l peas'") <br /> .�� -> 77 <br /> Type of Construction .f"'--rj Residential Use <br /> Occupancy Group fT j Proposed No.of Dwelling Units: <br /> Occupancy Load /4 /A Total No.of Dwelling Units: <br /> Fire Sprinklers Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes RNo <br /> Reason Sprinklers Required: F 17(Xt 5 7 "In Lieu" Fee:Type: Amount$ v <br /> Fire Alarm: 'Update Existing ❑New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: . E KL-e--air=.--? Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dis <br /> Add.'RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total$ zi-ey, t7X <br /> Approved By: Date: 46.(6, <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 /> / `❑Site Work or Drainage Proposed <br /> Approved By: [ Date: 7 //,.7/ � ❑Backflow Prevention for high hazard: <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 /> Fire Sprinklers , ire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> ❑ See 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 /> 0-Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K,ej(`pu,n Date: g-q 22I ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> a- <br />