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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 8 <br /> ZZo 1 - 637 <br /> BUILDING PLANNING <br /> Intake OK by: L1 Date: 6/r 6/? Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Route to Commercial Building4 <br /> El 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/ d r Rem Size 3620 'y ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone (4 1 <br /> Number of Stories ( Overlay/Agreement <br /> Basement KINo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use ' 1Q,(Y111 1 ory.e_ <br /> Occupancy Group W- Proposed No.of Dwelling Units: <br /> Occupancy Load TAU. Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System EI.Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes VfNo <br /> Reason Sprinklers Required: ]j "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System [9Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes r®�allo ❑Everett School Dist ❑Mukilteo School Dist <br /> Addl RCW 64.55 docs required prior to final? ❑Yes F No Additional Notes: <br /> VALUATION CALCULATION: Total$ 76,/o&(. <br /> Approved By: IL. Date: 'L. Z, Z'Z, <br /> ), <br /> UBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPWWorksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Backflow Prevention for high hazard: <br /> Approved By: r�,1L Date: j(0/2(0/2 2 ❑ <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 ❑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: ❑A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> 0 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 0 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: <br />