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• • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 52,106- 6 14 <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <br /> ❑ Route to Commercial Building ttach to Project No. ior Z1 —004 <br /> ❑ Route to Residential Building L_'I Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> BI g I/ ddn/Rem Size AT <br /> a2,fi ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /,4 4 Zone My <br /> Number of Stories / Overlay/Agreement <br /> Basement ❑No Wes, Fi l€nfi Nonresidential Use 6d I ,re,,1pL' <br /> Type of Construction la Residential Use a <br /> Occupancy Group ,73 Proposed No.of Dwelling Units: <br /> Occupancy Load 1/ Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update ExistingENew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: RUpdate 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? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: 96s/VANA\ to}-y_ per OO t'b$Z31,303100 <br /> VALUATION CALCULATION: Total$7S.v� �+ vvv/ CA'W`a��)J, 66� tAti' !t'etJ�rfm^e,r.�' <br /> Approved By: V , Date: ZI. Z<7 <br /> UBLIC WORKS . <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: iPWWorksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> i❑Site Work or Drainage Proposed <br /> Approved B Date: �� ./ <br /> ❑Backflow 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 <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: l El This Permit is Approved by Public Works <br /> IA00d Peer )i'i' ❑ 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> lEr Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:XAnzifin Date: g17.2;,2/ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: ZJ \ ) t Date: il Z ®'Z) <br /> 2/2 <br />