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0 0 -2_1 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ca'0 <br /> BUILDING PLANNING <br /> Intake OK b �� Dater/7 YC` Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size S ID 4-t-3' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone <br /> Number of Stories i Overlay/Agreement <br /> Basement al No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction '1 Residential Use <br /> Occupancy Group S- .. Proposed No. of Dwelling Units: <br /> Occupancy Load C.O ,,}}��,, Total No. of Dwelling Units: <br /> Fire Sprinklers: ID Update Existing ❑New System It 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 Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: - Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes IE No ID Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ©No Additional Notes: 4A r 14\vASN' 4Z 3 4 d <br /> VALUATION CALCULATION: Total$ C.a Ca;'`1--'2-42t &stk l. �'JC 4'-- o \ yfQ "S <br /> C <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: �-r"-2 Date: It it7 �,pa,t ❑Backflow Prevention for high hazard: <br /> 1 !(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT DRoute 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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred <br /> Additional Notes: 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 0 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 /> 3-Review/ Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:V___ r- ji c Date: i 1 - I ❑ Public Works has no scope---PW Not Required <br /> Additional Notes:�,j a �,U� .y� d, Ai .L ft <br /> ELECTRICAL • I�� Its l <br /> Additional Notes: 1 2- 08~0 in Zi� • 63 <br /> •Approved By: Date: Approved By: A-F,H Date: J,' / 22 <br />