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410 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ,W 7-i©21,'CD 1 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ElRoute to Commercial Building \ ❑ Attach to Project No. <br /> ❑ Route to Residential Building / ❑ Route to Historic Reviewer <br /> ❑ Makec this a"W" Permit El OK to Route to Other Departments <br /> Bldg ddn/Rem Size (o`T' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone V.) <br /> Number of Stories — Overlay/Agreement <br /> Basement ❑No EYes , Fin Unfin Nonresidential Use <br /> Type of Construction ` Residential Use aQ 5C".(2-- <br /> Occupancy Group Z - _. Proposed No.of Dwelling Units: <br /> Occupancy Load /4/A Total No.of Dwelling Units: I <br /> Fire Sprinklers: El 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: ❑Update Existing El New System ziNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: r Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes IFJ No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes tfiNo Additional Notes: Ar ci, ab /16 (9/\-- ri0-115 <br /> VALUATION CALCULATION: Total$ 6/, /co <br /> �S / Approved By: 1! ` Date: Z-Z b. Z <br /> P BLIC WORKS <br /> C` / Intake OK by: _ Date <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: / ' -- Date•62/aj/ / _❑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 I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers El 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 <br /> Fire Dept. Fees: 0 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 ❑ 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: <br /> ELECTRICAL — --N,{— j pl eil (r- © '( <br /> Additional Notes: l <br /> Approved By: Date: Approved By:` Date: 1 —/ 1 <br />