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0 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Z2<< 7._...-02-C) <br /> BUILDING PLANNING'' <br /> Intake OK by: Date: Intake OK bV Assign To: Dates <br /> Intake Comments: Intake Comments: <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 /> Bldg/TI/Ad i e ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,A/C) Zone I. :).) <br /> Number of Stories Z— Overlay/Agreement <br /> Basement 4No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction U4 Residential Use nr U I+I.-Pnili i i(, COndr� <br /> Occupancy Group ,'L Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing CI New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing CI New System egNot 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!RCW 64.55 docs required prior to final? ❑Yes -IE1No Additional Notes: <br /> VALUATION CALCULATION: Total$ZS 0062-av A <br /> Ta A kl) k (-- N( 170 / '()/2 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: i PW Worksheet Needed if: <br /> ❑Sys Dev Eval Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved Date: c..7 <br /> � � ❑Backflow Prevention for high hazard: <br /> �j __ :(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 OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional/ Notes: 0 This Permit is Approved by Public Works <br /> _/& O S?-40.� - ❑ 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 /> ❑ Revie / pection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved B -- -, Date.6^S/0517 CI-- Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />