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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# ?,2_fO6—03-S' <br /> BUILDING : PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> 0 Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size SO SY ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size /" G� Zone P-7-- <br /> Number of Stories / Overlay/Agreement <br /> Basement riErNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction .r7tC Residential Use cX, ,LJ <br /> Occupancy Group rite- Proposed No.of Dwelling Units: <br /> Occupancy Load .3 Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ONew System piNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes INKio <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: CI Update Existing CI New System Scot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Everett School Dist ❑Mukilteo❑ School Dist <br /> Add'I RCW 64.55 docs required prior to final? Yes No Additional Notes: ��� °a l 116 eV <br /> VALUATION CALCULATION: Total$ O ZW.OLP <br /> Approved By: 7y 'lie- Date: G, . il, ZI <br /> PUBLIC WORKS" <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> 'OSys Dev Eval ❑Traffic Mit Eval <br /> i❑Site Work or Drainage Proposed <br /> Approved -A+j! ?-' Date:409ZZAP�j DBackflow 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 ❑Fire Alarm ❑Other: AID] ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works } <br /> • <br /> IliriS ee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: VA Separate PW Permit is Required(Permit#: PWZI O7--472, ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Nils located in this folder <br /> Minimal or No Fire Scope-NO FIRE FEE 0 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:/7:34Gcl y) Date: 6 -gav ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> to <br /> Ti3 <br /> Additional Notes: �`� r �� 21 <br /> Approved By: Date: Approved By: •J Date: I <br />