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• <br /> Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT# V2101 'O 132 <br /> BUILDING PLANNING QQ / <br /> Intake OK by: Date: Intake OK by:oW Assign To ��£ Date:21Z/ _ <br /> Intake Comments: Intake Comments: t <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 ute to Historic Reviewer <br /> El Make this a"W"Permit ,OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 4,93 .4-- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone <br /> Number of Stories :L Overlay/Agreement <br /> Basement 1No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction \i Residential Use <br /> Occupancy Group e7 Proposed No. of Dwelling Units: <br /> Occupancy Load ,Z2— Total No.of Dwelling Units: <br /> Fire Sprinklers: F. lUpdate Existing El New System RINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers <br /> Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: rmUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: ►tvv�� Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? Oyes FE No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes I No Additional Notes: `�t/Ly�,,s,� <br /> 2.x."�� Aperpvca � 1^jGYK.- �J�t'GW2Gt Ur <br /> VALUATION CALCULATION: Total$ <br /> Approved By: O Date:Co,Z( , 2J4 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: !PW Worksheet Needed if: <br /> IDSys Dev Eval ['Traffic Mit Eval <br /> I DSite Work or Drainage Proposed <br /> Approved By: �!' Date: /(1._-/-i �zt ❑Backflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary,hospital, <br /> VVV 2 !supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> 0 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 ��,, i�.�� AND ❑ Is located in this folder <br /> o Fire cope- I`"' ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> VI-Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K.2"NaRr Date:S// / la Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: 4 /Qak i it <br />