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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 921 <br /> BUILDING PLANNING <br /> Intake OK by: Date: d ( Intake OK by://6 Assign To:f-f -04 g. Date: 4.J J'/ <br /> Intake Comments: Intake Comments: <br /> D Route to Commercial Building ❑ Attach to Project No. <br /> -Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit al4sK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size (Q40z II Hold in Planning File Drawer <br /> ',Garage/Accessory Struct. Size 400 _ 4-2 Zone <br /> Number of Stories 1 Overlay/Agreement <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction (rZc. Residential Use cSF.— <br /> Occupancy Group 1 e2G Proposed No. of Dwelling Units: <br /> Occupancy Load I R.G- Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing El New System rgiNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: _ Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ENo Additional Notes: <br /> VALUATION CALCULATION: Total $ 1 (P. / (Pro <br /> '1.00 )( 12,1.0 145, 0 <br /> 0 <br /> �Od �{t,� lotI ZED Approved By: a Date: —]/1 3 f ZOZ4 <br /> go ip30 i0' <br /> PUBLIC WORKS <br /> t1o' l ta,oD.°% Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> OSite Work or Drainage Proposed <br /> � <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: <br /> c f ej Date: (p -1,/yd2, `(dental,medical,animals,mortuary,hospital, <br /> 'supportive 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 /> DFire Sprinklers ❑Fire Alarm DOther: 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 21UL/-'01,E <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 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 /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: -oWr Date: I-1 'c2',4\ ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: 1 Zl D11.- 0 <br /> Approved By: Date: Approved By: 113 Date: <br />