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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# T2 (1 0 I Li) <br /> BUILDING PLANNING <br /> Intake OK by: 411-7 7 Date: �� // Intake OK by. S ZG Date: -y <br /> Intake Comments: Intake Comments: Assign To: . ?0\\NNC\ <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ,,►:4 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 5,' Z S Zone - \ <br /> Number of Stories l Overlay/Agreement <br /> Basement EZNo DYes , Fin/Unfin Nonresidential Use <br /> Type of Construction �a Residential Use Ae. C A. Tra(y. <br /> Occupancy Group u Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: C , <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes 154No <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? DYes 21 No DEverett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes E No Additional Notes: <br /> VALUATION CALCULATION: Total $ 3qt 4.7(p �p.; 4,\\ \,),Al c G \Cep, c-io,C it3 ,coki(i(`it <br /> \A'sQecX-vzyk <br /> Approved By: _.....4Date: q, ` ,SC)01,9 <br /> PUBLIC WORKS <br /> Intake OK by: .KA Date: 5 17 j2 I S <br /> Additional Notes: 20 is- 12 C Intake Comments: PW Worksheet Needed if: <br /> 1kE v..t CmAct-A-G►e: LSys Dev Eval ❑Traffic Mit Eval <br /> 5£V' Ate_ . 16..-4 <br /> Approved By: Date: -L lxfffl S F a- v,..-dew mite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Q <br /> !! �� 5£—F C4,/4,1,4._ ?it,s_aArt' (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT/� Route <br /> this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Requ jd: IT1This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm / Other: AND ❑Create Green Folder ❑Submitted Previously 16:_tDeferred <br /> Additional Notes: r Ef-Ms Permit is Approved by Public Works <br /> 0 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 Pt'ans-NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No Fi Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Insp ction 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 -5 tE C 006 mac,3 c PvJ 0 v u- �S( <br /> Additional Notes: <br /> Approved By: Date: Approved By !�"L Date: //key(/ ? <br />