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410 <br /> ER �Zo Z -0(9 <br /> Intake &Approval Sheet (FOR PERMITSTAFF ONLY)O � PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:Of) Assign To:I'iaX.. Date: g/zl ae4. <br /> Intake Comments: Intake Comments: <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 . -i2,( --t-` ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ®No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction i - Residential Use <br /> Occupancy Group r - L Proposed No.of Dwelling Units: <br /> Occupancy Load '3 Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ONew System ®Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: nil Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: IIC� Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? El Yes El No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes INo Additional Notes: <br /> VALUATION CALCULATION: Total$ 34,00 <br /> Approved By:O:f Date: 3/24 2027__ <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: FM;Work sheef Needed If.•.- _ ..,_ --- <br /> '❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: Date: '318 r 2_ (dental,medical,animals,mortuary,hospital, <br /> `t 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 /> El Fire Sprinklers , ire Alarm ❑Other: AND OCreate Green Folder OSubmitted Previously ODeferred <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 ❑ 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 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg). <br /> Approved By: �,; (, (j/(\Date: aPublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />