Laserfiche WebLink
III <br /> Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) PERMIT# efia-A0 �� <br /> �nQ BUILDING PLANNING <br /> Intake OK by: 1�-Q�'C Date: 47%1ti_. Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> Fil Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/ d m Size ) 53 0 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone 1 <br /> Number of Stories 2 Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 5f UV <br /> Occupancy Group 11.t: Proposed No.of Dwelling Units: --- <br /> Occupancy Load - Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ❑New System Shot Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System Mot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes fNo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 10 No Additional Notes: Lai <br /> VALUATION CALCULATION: Total $ 30 !CD <br /> Approved By: % .2 -...,BLIC WORKS <br /> J � <br /> Intake OK by: 'T Date: (Q(t.E1 JL <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 1 yr£R,ta re— 01444 1❑Sys Dev Eval ❑Traffic Mit Eval <br /> ,,,gyp Psaa ❑Site Work or Drainage Proposed <br /> ScoPC ❑Backflow Prevention for high hazard: <br /> Approved By: (2'Pi Date: Wei j2y <br /> (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 /> ❑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: 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 (loin 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: Date: Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: 6v/zz/fL .z-t' <br /> Approved By: Date: Approved By: Date: <br /> ZI- <br />