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• • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Bt qog_0(,P <br /> BUILDING PLANNING <br /> Intake OK by: Date: $l /IF Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/ ccesso y truct.Size 7 2 S,F. Zone g-5 <br /> Number of Stories 1 Overlay/Agreement <br /> Basement ENo DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction ` A Residential Use <br /> Occupancy Group lit Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El 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? DYes Igi No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 1No Additional Notes: {i/tp,tG\ VeI/ a— 0 ..) it <br /> VALUATION CALCULATION: Total$ i O(J g}t,o„" e�C or/ i^ ;,r- 4i `�s <br /> PA-- or--- -\1.. ryv0 s - <br /> Approved By: �. ), Date: ' (,„l9 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 2 0/S' / C Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Mite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: jit Date: gAet/I9 <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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> NOf N4( f ) El 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 /> 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 'fr <br /> Additional Notes: <br /> Approved By: Date: Approved By: 13C 4A/I/1, Date: g Joip 12O Y ) <br />