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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 13�208-*og <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: • Intake Comments: <br /> • <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑Make this " " ermit El OK to Route to Other Departments <br /> Bldgffl/Ad m Si �70t71YP ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ✓r/�i Zone 143 <br /> Number of Stories Overlay/Agreement <br /> Basement JONo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction .ACZ Residential Use <br /> Occupancy Group 5 Proposed No.of Dwelling Units: <br /> Occupancy Load 7.: Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System r INot Req'd Planning/Landscape Inspection Requi d before Final? Oyes ArNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System L]Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: rJv Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes M No DEverett School Dist ❑Mukilteo School Dist <br /> /� <br /> Add!RCW 64.55 docs required prior to final? Dyes '�No Additional Notes: ; 0 &i::A. <br /> ins <br /> VALUATION CALCULATION: Total$ 777,ra? 0,.) flb n_ns i <br /> Approved By: y., <br /> r r / Date: CI i 9 77 . <br /> BLIC WORKS <br /> Intake OK by� Date:...,..,,..�Sl.28124D Uv.,.,m.,.,,.-,,..,.,.., <br /> Additional Notes: Intake Comments: £PW Worksheet Needed if: <br /> OSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved Iiii4 `'"" Date: `07A 02-L =lDBackflow Prevention for high hazard: <br /> // ;(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT El 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 DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: svJ 5-6,P, ❑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(join with this folder for permit issuance) <br /> ❑Review/I ection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved B ,jk ` Date: (' Y 2/' z.r Public Works has no scope PW Not Required <br /> / Additional Notes: <br /> ELECTRICAL \ p`�1/� (("4"} <br /> Additional Notes: J <br /> Approved By: Date: Approved By: PAANIA.6/Asio)Z31lad UL� <br />