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410 <br /> Intake &Approval Sheet 1111 (FOR PERMIT STAFF ONLY) PERMIT# C/(61 'D 10 <br /> BUILDING l PLANNING �f <br /> Intake OK by: cj h ' Date: 9/ of Al Intake OK by:a/6 Assign To:g/I 7/I q Date:T L X <br /> Intake Comments: Intake Comments: / � <br /> `Ve tii_.ECGHW 'a/ fftc+ 1Fees , Cct I hT7 /t(- -( <br /> vae rodvv� oiv ice ( see �� a4\koNA ive.A <br /> ❑ Route to Commercial Building El Attach to Project No. <br /> CN ,� .�� <br /> Route to Residential Building ❑ Route to Historic Reviewer <br /> ID Make this a"W" Permit a,OK to Route to Other Departments <br /> ___.__. .. . _. <br /> Bldg E. <br /> /TI/Addn/Rem Size tGt El Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use -- , .n <br /> Type of Construction Residential Use Sf, '- Y 1 DU <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: 2. <br /> Fire Sprinklers: ❑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 ❑New System ❑ jNot Req'd ,School Impact Fee: Total $ I/ 2c- <br /> — <br /> Reason Fire Alarm Required: �f C Iculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? Oyes ❑ No PI Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 does required prior to final? Oyes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 1 5-00 <br /> Approved By: Date: 2.JZ(p/u� <br /> PUBLIC WORKS / <br /> Intake OK by: I IO Date: 9 , i I ` <br /> Additional Notes: Co is- //zC.. $ �I Sac_ Intake Comments: PW Worksheet Needed if:''ta__ <br /> T ^^E^d" -P4"< C. 4. ❑Sys Dev Eval ❑Traffic Mit Eval <br /> —Ta, ILVP t) I❑Site Work or Drainage Proposed <br /> /�� jOBackflow Prevention for high hazard: <br /> Approved By: Date: I � ��7 a:z-.F-.a t� <br /> ,S.?�G I co O sr ;(dental,medical,animals,mortuary,hospital, <br /> isupportive 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 /> '1 Cif <br /> Additional Notes: ? This Permit is Approved by Public Works <br /> ,See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: rig-A Separate PW Permit is Required (Permit#: PW VI li- 0 4 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND IZLIs 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 <br /> Additional Notes: <br /> Approved By: Date: Approved .. Date: I I DZ Z 1 F <br />