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Intake &Approval Sheet *FOR PERMIT STAFF ONLY) PERMIT# 6421ofq---o02( <br /> 'p BUILDING : PLANNING' • • - . . <br /> • <br /> Intake OK by: (2-Q rk Date: q' 1=-- Intake OK by: Assign To: Date: <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/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone RI <br /> Number of Stories 2 Overlay/Agreement <br /> Basement ❑No ElYes , FinGil') Nonresidential Use . <br /> Type of Construction Residential Use SFIi _ <br /> Occupancy Group Proposed No.of Dwelling Units: . <br /> Occupancy Load • • Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ❑New System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes filNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: 1i IA Amount$ <br /> Fire Alarm: ElUpdate Existing ElC�New System Not Req'd School Impact Fee: Total $ 0 l A <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 44 No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EryyNo Additional Notes: /' <br /> VALUATION CALCULATION: Total$ 66 C)cD ,z`Mpt, ccOrr ?wrti NL <br /> �N►Pp.oi t Qoe &AG gt•S4,4LD <br /> Approved By: Caiik"t%1. Date: Li Sp UM. <br /> PUBLIC WORKS` <br /> . <br /> Intake OK by: Date: of 141f <br /> Additional Notes: pf n Imo Intake Comments: `PW Worksheet Needed if:: <br /> SPED.A-L 1 Q S` 10 S ?I,Q DSys Dev Eval ❑Traffic Mit Eval <br /> iOSite Work or Drainage Proposed <br /> Approved By: Date: /l?. Z44Z OBackflow Prevention for high hazard: <br /> :(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 /> ❑Fire Sprinklers OFire Alarm El Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> Additional Notes: 0 This Permit is Approved by Public Works w' <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: V Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL Additional Notes: J\.?.k'YYM/V " c Lt l 2J'2 <br /> Approved By: Date: Approved By: Date: <br />