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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) 411, PERMIT# Vur-1_b' 3 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: 5�0� <br /> 01.19,61-r <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this <br /> a�" rmit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn7Re 64-O j$'f ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size / Zone �v <br /> Number of Stories Overlay/Agreement �" <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use Y'lnlly+ua� p r Y(L 0 aAv-) <br /> Type of Construction 7 '.Q Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑YesVNo <br /> Reason Sprinklers <br /> Required: "In Lieu"Fee:Type: Amou f <br /> Fire Alarm: IrEilUpdate Existing El 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 ❑Everett School Dist ❑Mukilteo S ool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 470,7CO,-DO <br /> Approved By: \IL Ativdp Date: -1 ,ZJ.7i� <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved Date: .07/ /7ZZ_ 1❑Backflow Prevention for high hazard: <br /> I(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 ❑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: ❑ 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 /> eview/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: j ro[.0 n Date: 6— 6 Z2 ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: 217, <br />