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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) . PERMIT# FZ' 5."074 <br /> BUILDING PLANNING'Intake OK by 1`- - Date:0-7)„, �7i 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 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone t/12_ <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Oyes, Fin/Unfin Nonresidential Use . <br /> Type of Construction - Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: /1--, ' <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑YesNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ / <br /> Fire Alarm: El Update 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 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: A , is �liiC �" � ���� n <br /> VALUATION CALCULATION: Total$ 600Oa b® ,,.. a,,r C0_,•A'� pla,,g-t afera�-1CX t� <br /> a 0�� <br /> Approved By: 4., , Date: ,"7• Z—Z <br /> • UBLIC WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: ipW Worksheet Needed if: <br /> 'DSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> � IOBackflow Prevention for high hazard: <br /> Approved B Nit. il//.�-tt Date: t2 ^y •2,02e.._ _(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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: .; . , his Permit is Approved by Public Works <br /> rig-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 /> ❑ 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 <br /> Additional Notes: <br /> Approved By: Date: Approved By � Date: (o 4,1�41-74122 <br />