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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# B2103- 01 a <br /> BUILDING s ' PLANNING <br /> Intake OK by: Date: Intake OK by:g47 Assign To:f1A.Ng Dater [Ll <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ -.ute to Historic Reviewer <br /> ❑ Make this a"W" Permit ' OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 7J/ 70.1. 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone LSZ <br /> Number of Stories / Overlay/Agreement <br /> Basement EliNo ❑Yes, Fin/Unfin Nonresidential Use 11 -f-,I , t f l' L1 ki61 <br /> Type of Construction (/ —. Residential Use <br /> Occupancy Group ,1?/ / Proposed No.of Dwelling Units: <br /> Occupancy Load !.11LtS Total No.of Dwelling Units: <br /> Fire Sprinklers: ErUpdate 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: MUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: � Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑ {Yes --Er No ❑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 $ ,;'-,.f <br /> Approved By: L�, Date: ti 1 /f 2-��>%., <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: (PW Worksheet Need dif: <br /> l�T4 Y 1 <br /> ❑Sys Dev Eval Traffic Mit Eval <br /> ` 1� ,�'p G =❑Site Work or Drainage Proposed <br /> Approved By: -- Date:L`�j`t / .-i c6t a�XIC '❑Backflow Prevention for high hazard: <br /> p�� :(dental,medical,animals,mortuary,hospital, <br /> ``l\ tq"�` . isupportive 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 ❑Fire 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 N/Pr- <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 /> El Review/Inspection Scope-ADD FIRE FEE ElWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> i <br /> Approved By: : a , ,.,/_ . Date: L( 13 / 2 ! ❑ Public Works has no scope---PW Not Required <br /> v ; Additional Notes:I JY1 . �.,-1-- as <br /> ELECTRICAL; n\t5it 't lW� E E i ft'�I3 <br /> Additional Notes: 3 11v" <br /> 11t.e , � p,l , S' „„. "� �' ijl Sh,. <br /> Approved By: Date: Approved By: V _ Dater .7 �� .L ,' <br /> 2-/y <br />