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Intake &Approval Sheet • PERMITS F 'pp (FORSTAFF ONLY) PERMIT#� � O—n <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> CI Route to Commercial Building El Attach to Project No. (1•Er\r5---R O \ <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 6,-i-g ---1-1 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone /,� <br /> Number of Stories i �QusK�ent C 'C <br /> \@_AA <br /> Basement allo ❑Yes, Fin/Unfin Nonresidential Use (��\ ' - <br /> Type of Construction , rsicient - \ 14(Al- <br /> Occupancy Group a - d- Proposed No.of Dwelling Units: `C` <br /> Occupancy Load 2. Total No.of Dwelling Units: <br /> Fire Sprinklers: 1 IUpdate Existing IYONew System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason SprinkieKs Required: �'' $ t►w'rw"-sc" "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: !a4 Update Existing Chew 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 pi No ❑Everett School Dist ❑Mukilteo School Dist <br /> Addl RCW 64.55 dots required prior to final? ❑Yes ES1No Additional Notes: <br /> VALUATION CALCULATION: Total$ )otrj) 02-0• .4--co <br /> Approved , Date: gait <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: 5f"1RP4 P-'t"bi+ Irt.5r+a-4.amo+-1 Intake Comments: PWWorksheet Needed if: <br /> =OSys Dev Eval ['Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Date :�._ 3 2 _1 `(]Backflow Prevention for high hazard: <br /> Approved By: <br /> 11 ( _(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: DThis project also has a separate concurrent PW Review(Green Folder) <br /> p <br /> ire Sprinklers Fire Alarm ❑Other: AND OCreate Green Folder OSubmitted 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:‘< frC.c)A Date: 7-/q-,ZZ ❑ Public Works has no scope--PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />