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0 • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# .2,`02:-b 65 <br /> BUILDING - / PLANNING <br /> Intake OK by: L�� Date: ° 1 ,i' Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> kk❑,,,, Route to Commercial Building ❑ Attach to Project No. <br /> d'1 Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/ n Rem Size 432. - .-2 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories 2... Overlay/Agreement <br /> Basement IJSNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction iC, Residential Use '. I2. <br /> Occupancy Group I CZe....- Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: k <br /> Fire Sprinklers: ❑Update Existing ❑New System rallot Req'd Planning/Landscape Inspection Required before Final? ❑Yes I JNo <br /> Reason Sprinklers Required: "In Lieu"Fee: Type: Amount$ / <br /> Fire Alarm: ❑Update Existing El New System I1 Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ® No El Everett School Dist ❑Mukilteo Bchool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes E No Additional Notes: 05.,„e_ d rre64\ ,A. ,4Creo <br /> VALUATION CALCULATION: Total$ 50100P Ldeco16 J7 t'Lf . , �, '''= j t/p,L i\- <br /> Approved By: Date: ,, er.. 2_1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: !PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> , <br /> Approved By: Date: to(9,q„1 £❑Backflow Prevention for high hazard: <br /> l i(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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El 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 i ❑ 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 By: Mk Date: 3/ OBI IA <br /> Z <br />