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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) S PERMIT# g(2--t D'--ob c1 <br /> BUILDING /� PLANNING v <br /> Intake OK by Date: a7 7Au Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> 0 <br /> Route to Commercial Building ❑ 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 /> c.Bldg/TI/Addm Siz 3,1f3 Zf 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone ) _ <br /> Number of Stories Overlay/Agreement _ <br /> Basement rziNo ❑Yes, Fin/Unfin Nonresidential Use . %) criuA\\--) <br /> Type of Construction Ji/3 Residential Use <br /> Occupancy Group 49-3 Proposed No.of Dwelling Units: <br /> Occupancy Load 1 '/S/ Total No.of Dwelling Units: <br /> Fire Sprinklers: PtUpdate Existing aNew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes -111\10 <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Ellipdate 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 q No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes &INo Additional Notes: \ N (V CVN <br /> VALUATION CALCULATION: Total$/ 3)t') 0,b 01 <br /> Approved By: �. Date: %` L-lii <br /> PUBLIC WORKS- <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> 0Sys Dev Eval ❑Traffic Mit Eval <br /> • <br /> =0Site Work or Drainage Proposed <br /> Approved By-,. /Date://��/�� ❑Backflow Prevention for high hazard: <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 I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> 0-Fire Sprinklers }'{moire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ElThis Permit is Approved by Public Works <br /> 1 di`4CJIen 14°Cd SrZ--- ni (i<) ❑ 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 /> El Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ob(�h�'/ Date:/f illitAlc, El Public Works has no scope---PW Not Required <br /> ��ii Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2/ <br />