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• •Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 137-201 - 04° <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: a ) Assign Tot'U.1/1K Date: ZH/Z2- <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ R ute to Historic Reviewer <br /> Cl M.,.- this a"W"Permit K to Route to Other Departments <br /> Bld ddn/Rem Size t9bi- 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone t <br /> Number of Stories / Overlay/Agreement <br /> Basement glNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction V ^3 Residential Use <br /> Occupancy Group 137 Proposed No.of Dwelling Units: _ <br /> Occupancy Load f g' Total No.of Dwelling Units: <br /> Fire Sprinklers: Update Existing El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprink ers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: pdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: -c 72i, 15 ft�Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No DEverett School Dist ❑Mukilteo School Dist <br /> Add]RCW 64.55 docs required prior to final? ❑Yes biNo Additional Notes: <br /> VALUATION CALCULATION: Total$ I0 j Cge" <br /> cAi <br /> D l, G Date: Z /ZZ <br /> /V k IL( n6f ib ItG�l� Approved By: <br /> I <br /> b ri a,� ;���,�,� n fle11 „ ° PUBLIC WORKS <br /> /1 !�Y l�W �Vf`� Intake OK by: . Date: <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if: <br /> OSys Dev Eval ❑Traffic Mit Eval <br /> „ iDSite Work or Drainage Proposed <br /> Approved By: ///Date: >� -7/" P— =OBackflow Prevention for high hazard: <br /> f l(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 /> El Fire Sprinklers iaFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: A7wh Date: ;24 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: IT?) Date: 1/7Jf7o77 <br />