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0 • 1 U <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# W2l 0Z" V l3 <br /> BUILDING PLANNING <br /> � <br /> Intake OK by: Date: Intake OK bye tja Assign To: (,•?d • Date:/I 2_J <br /> Intake Comments: Intake Comments: <br /> flc8 rvtty ve relv'(ed . <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit I,a OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size L'- '1‘)-7 )t,- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone U V.4 <br /> Number of Stories — Overlay/Agreement <br /> Basement 0-No -Elyes -Fin/Unfin Nonresidential Use _ <br /> Type of Construction _ Residential Use DUO-)6 <br /> Occupancy Group f�C Proposed No. of Dwelling Units: <br /> Occupancy Load LL� Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑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 bNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 11 No 0 Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EI No Additional Notes: <br /> VALUATION CALCULATION: Total$ ..3(/ OcZ, <br /> Approved By: 7l -, Date: r /2 1 /2 c i),.1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> j !i4 (/ <br /> Jcrttm-4L g . iodiA' =❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> l� r Date: 5'/ / ❑Backflow Prevention for high hazard: <br /> Approved By: <br /> / / r _(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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> 0 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O 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: Lr Date: 5 /yaz <br />