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Intake &Approval She* (FOR PERMIT STAFF IY) PERMIT#12.0ar 0(5_ <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 /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size SOO / 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ,DES Zone 2- L <br /> Number of Stories ��5yZ Overlay/Agreement <br /> Basement �INo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction LIt.< Residential Use6.614)\N-4L <br /> Occupancy Group ,4--,i[.e_ Proposed No.of Dwelling Units: <br /> Occupancy Load 6' Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing El New System VNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes Cle <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System 63Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$46SO( 6t <br /> Approved By: , Date: 1.1-1 LIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> Mite Work or Drainage Proposed <br /> Approved B �,,��� DaterAirt,0� �Backflow Prevention for high hazard: <br /> / i(dental,medical,animals,mortuary,hospital, <br /> !supportive housing) <br /> FIRE DEPARTMENT El 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 El Fire 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: ❑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 folderfor 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: Date: 1,Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: _ <br /> Approved By: Date: Approved By: Kk-tt Date: %o bt 1.0 <br /> 4 <br />