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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 110 PERMIT# '' ' D' D" ) <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: "peel Assign To: Date: It 0 d' 2411 <br /> Intake Comments: • Intake Comments: <br /> • <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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone V i.4 <br /> Number of Stories Overlay/Agreement <br /> Basement No DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction V }. Residential Use MC `� L .040040 <br /> Occupancy Group e2.. Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: Ph C 1.441y4, <br /> Fire Sprinklers: DUpdate Existing ❑New System INot Req'd Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Reason Sprinklers Required: nh in Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing❑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? FlYes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ®Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ VA;4700 <br /> Approved By: W, Date: l' Oat Tat <br /> PUBLIC WORKS <br /> Intake OK by: % Date: 1lJ 1...Q Pi'111----- <br /> � <br /> Additional Notes: izenils- c,RAt,_� Intake Commen pWWorksheetNeededif: <br /> DSys Dev Eval )]Traffic Mit Eval <br /> l❑Site Work or Drainage Proposed <br /> Approved By: Date: � 1«'-x��?i I DBackflow Prevention for high hazard: <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: OThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <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 0 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 /> ❑Review!Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: C4 Public Works has no scope--PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: ID (o.j I ft)L2 <br /> Approved By: Date: Approved By: ' Date: <br />