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• <br /> .-. 0 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0 0\5 <br /> BUILDING PLANNING Intake OK by: Date. Intake OK by:<—.c5 Date: �,1\-On`_1 <br /> V <br /> Intake Comments: Intake Comments: Assign To: <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 '„E ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone A- <br /> Number of Stories 2- Overlay/Agreement <br /> Basement pNo ❑Yes , Fin/Unfin Nonresidential Use `��\01. * ‘30 6041.k <br /> Type of Construction Y8 Residential Use <br /> Occupancy Group -$ Proposed No. of Dwelling Units: <br /> Occupancy Load LP Total No. of Dwelling Units: <br /> Fire Sprinklers:glUpdate 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: Pi 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 rI No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 1aiNo Additional Notes: (�0 VALUATION CALCULATION: Total$ Qa 41°1.&I v�, 6,k0'A(/ \)ISCS <br /> Approved ---") Date: t,\\.Zt;}'\q <br /> PUBLIC WORKS <br /> Intake OK by: WI Date: P*074!"2 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> � /_4. �7 � ❑Sys Dev Eval ❑Traffic Mit Eval <br /> i , <br /> / /7 b C Q t.... ❑Site Work or Drainage Proposed <br /> Approved By: Date: 4 1 III ITT Ode- . ❑Backflow Prevention for high hazard: <br /> (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 /> El Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 ❑ 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 /> Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ir/q i n Date: 4-3er—/? Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: :YitE_A Date: 47,r:'Ib y <br />