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0 • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (J 11 ((D —d JS <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:olf) Assign Tor t ) L. Date:to .9.,24024 <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"Permit XOK to Route to Other Departments <br /> Bldg/TI/Ac:/Rem SJ 523 IF ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /I/O Zone LTZ. <br /> Number of Stories 1 Overlay/Agreement <br /> Basement Olo DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction V—,9 Residential Use <br /> Occupancy Group /7/ ,//,,sue/ Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers:IxiUpdate 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: MUpdate Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes A No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes No Additional Notes: No e�(.teiric( may.y. �VI �or d,p� <br /> VALUATION CALCULATION: Total$ /ZL1a.2 with fh:S permit JN`O Gha►�l i'i'n uctarrov`T- . <br /> Approved By: u Date:Gj ,1.202.4 <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPWWorksheet Needed if: <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> !Mite Work or Drainage Proposed <br /> Approved ✓`�G'y Date-l�, ,,,''01j, =OBackflow Prevention for high hazard: <br /> _(dental,medical,animals,mortuary,hospital, <br /> _supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet a <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder OSubmitted Previously ❑Deferred <br /> Additional Notes: 0 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 /> jiL.Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(loin 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: .Rx-6,(.vh Date:6..2.2 ,' ❑ Public Works has no scope---PW Not Required <br /> 'Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />