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0 • { <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �Jr4---0O: <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> O Route to Residential Building 0 oute to Historic Reviewer <br /> El Make this a "W" Permit -.)i G''' OK to Route to Other Departments <br /> Bldgrtl/Addn/Rem Size ../i rSij 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 61/ S.F. Zone - <br /> Number of Stories L Overlay/Agreement <br /> Basement 51-No ❑Yes , Fin/Unfin Nonresidential Use <br /> r-7 <br /> Type of Construction /rr, Residential Use ST12 <br /> Occupancy Group /` 3 Proposed No. of Dwelling Units: <br /> Occupancy Load / Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System 5tNot Req'd Planning/Landscape Inspection Required bef••' Final? ' "Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: t$ <br /> Fire Alarm: ❑Update Existing El New System Not Req'd School Impact Fee: Total $ • J0 <br /> ____ <br /> Reason Fire Alarm Required: !!44ff Calculated: 14/ 2- 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 grit r1,1 No Additional Notes: <br /> VALUATION CALCULATION Total $ 3 F;007.co VrIGISO?"(r (ASP,-c f(� r <br /> 3aDOy)c I7( (. 3G31_ 1 "" <br /> 60C 5=>, �f8 : . . '�(j Approved By:( Date: I )17/Z <br /> 3 Z� PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PWWorksheetNeededif: <br /> i❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By.... ...._ \JR4/` Date: /` / ❑Backflow Prevention for high hazard: <br /> JJ /�, �' (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: d This Permit is Approved by Public Works <br /> Q See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW 2401-_0'4' ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> Et Minimal or No Fire Scope-NO FIRE FEE Ells in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: k jareGon Date: 7—/y..?0,20 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: —, Date: 3 A 1' <br />