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• <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONL.19 PERMIT# S Z\O °O I <br /> BUILDING PLANNING C�i�,�,,, ll A <br /> Intake OK by: Date: Intake OK b Assign To �ICQ Date:,V'"1. l- <br /> Intake Comments: Intake Comments: \ J\t <br /> Lta,eg\QT4fl <br /> , ,,,,, ,,,,,,Asi.r .c.,,,AckA., ,,,k_ <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer I.Nk <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments ,p A.Q_ S1\ <br /> Bldg/TI/Addn/Rem Size • 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay 'rt I S N lQ `ph <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use �' ,,r�,,,,.Q Q ' \ � _ :J_ <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not 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 ❑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 School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$4/ 700o°® \CZ Sc „ '(•J\VKC 1A Y``W'C-c\ <br /> Approved Date: `, 2!J/.tOtt ` <br /> PUBLIC WORKS <br /> Intake OK by: . Date: ___ _ <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if. --....W,._,�,- <br /> _DSys Dev Eval ❑Traffic Mit Eval <br /> .A.- 0��/ DSite Work or Drainage Proposed <br /> 'DBackflow Prevention for high hazard: <br /> Approved B Date:O,B/)O ridZI _(dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end —PW Review Worksheetry __ <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 0 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: Date: Public Works has no scope---PW Not Required <br /> dditional Notes: br` ,f/0_ pole 2/ II p Vd pOse <br /> ELECTRICAL 1 6 be re owe ( . <br /> Additional Notes: <br /> Approved By: Date: Approved B • Date: 1 fi 16-I -262,I <br />