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0 • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONL� PERMIT# bnQO - OAS <br /> BUILDING ' /Th PLANNING <br /> Intake OK by.4_Apr__' Date: 40/497241fq Intake OK byc Date: 't - • - 2-0\� <br /> Intake Comments: Intake Comments: Assign To: 11Lc\. <br /> E5/z, _,gl�.7 teerww.�2o 0 <br /> .SSP/2C CZ. CJ <br /> ❑ Route to Commercial Building S(2.0, 0 Attach to Project No. <br /> ❑ Route to Residential Building -- ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit El OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone 'K— <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use t- <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: C>i\R <br /> Fire Sprinklers: ❑Update 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: ❑Update Existing ❑New System ID 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 ❑ 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 $ <br /> Approved B 'V Date: tit_ 1,4. Za tQ <br /> PUBLIC WORKS <br /> Intake OK by: —11a Date: a Izo /zo i 9 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> IZMS 1w14 Coo*la'7A i"•o.J ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Ye-4777. Date: /9 G/l g ❑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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 AND ❑ Is 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: Date: EX-Public Works has no scope---PW Not Required <br /> Additional Note e rut )1.ot 9 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />