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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#b2-CC) [C-0 <br /> BUILDING PLANNING: <br /> Intake OK by: Date: Intake OK by: Assign To: Date:sl—V <br /> Intake Comments: Intake Comments: <br /> nOel , ‘e• G)Q4c9-S <br /> YW .5k. e\tk S <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 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 4-ley /77 67 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone N\ -\ <br /> Number of Stories / Overlay/Agreement <br /> Basement tallo ❑Yes, Fin/Unfin Nonresidential Use \id \`Mq d‘‘11:r]018AOL , <br /> Type of Construction /%% (,? Residential Use <br /> Occupancy Group - / 5_ / Proposed No. of Dwelling Units: <br /> Occupancy Load 0-jj; 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: 4 1' I6-i:v/r: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: 13Update Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Z F ,r.13a��'t.4 Yam} Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 Everett School Dist Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes DNo Additional Notes: <br /> VALUATION CALCULATION: Total $ cTJ-)!(,l <br /> Approved By: CSL Date: ' - \ , <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: Ipw Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: � Date: 1 �/�,() 1(dental,medical,animals,mortuary,hospital, <br /> ;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 /> LFFire Sprinklers irfrire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: EfThis Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required(Permit#: PW ) <br /> ti Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> O 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 ElWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: L2F Date:70 /" E/Public Works has no scope--- PW Not Required <br /> f Additional Notes: <br /> ELECTRICAL go aal* s,s A fl ftts aUr, <br /> Additional Notes: M USE'. <br /> Approved By: Date: Approved By: Date: : -12 if z zo <br />