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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) . PERMIT# f t' L 2-'01v <br /> BUILDING ) / //� PLANNING/ <br /> Intake OK by: Zl' Date:\�/�/)`i Intake OK by:Of:/ Assign To: '{7" t Date: 12-MI t i _ <br /> Intake Comme4: .P�Mgt t �tT Intake Comments: <br /> - ties,t Mt r <br /> 4 Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit VOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size (2..00C) ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone UM <br /> Number of Stories J Overlay/Agreement <br /> Basement ❑No ®Yes , Fin/Unfin Nonresidential Use C C _ <br /> Type of Construction $.- A- Residential Use <br /> Occupancy Group la, Proposed No.of Dwelling Units: <br /> Occupancy Load 12-12 Total No.of Dwelling Units: ---._-- <br /> Fire Sprinklers:0Update Existing ❑New System CI Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes I3IUo <br /> Reason Sprinklers Required: "In Lieu' e: Am <br /> Fire Alarm: El Update Existing El New System El Not Req'd School Impact Fee: Tota <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes 0 No DEverett S Dist ❑Mukilteo School Dist <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes 'No Additional Notes: <br /> VALUATION CALCULATION: Total$ 20, el-II 14 O' (la- no cMan?e -vim , <br /> Approved By: (�(/� Date: 1211 (/i <br /> "VV'' PUBLIC WORKS <br /> Intake OK by:) Date: 12 1 ZOI9 <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: 0,,,- <br /> /JJf fYrLY- A.,.�-t„�j DSys Dev Eval DTraffic Mit Eval <br /> {�( I 1 ����/ I ElSite Work or Drainage Proposed <br /> Approved By: r� Date: (,'?_ t tq, n i'ne' ttei-a . IDBackflow Prevention for high hazard: <br /> II ' I ��I :(dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT DRoute 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 IZIL Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: El This Permit is Approved by Public Works <br /> V-Gt)I C4 Pal tt h y(45 o,- e( ce✓f 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 /> 0 Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: 6 Date: 12/// dPublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: A&Ng-- Date: f<2,70 ,, <br />