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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT# 10 22�p-0 6 <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK by: 'Db Assign To: Date:11 0 it UM <br /> Intake Comments: • Intake Comments: <br /> • <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/Tl/Addn/Rem Size — ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone I/0.4 <br /> Number of Stories 3 Overlay/Agreement <br /> Basement INo ❑Yes, Fin/Unfin Nonresidential Use i Type of Construction V 41 Residential Use Mv1'1`+ kw„17, I'w k c1-4541+- <br /> Occupancy Group R2 Proposed No.of Dwelling Units: <br /> Occupancy Load — Total No.of Dwelling Units: A e1►0r, . <br /> Fire Sprinklers: ❑Update Existing ❑New System 1'4 Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing❑New System INot Req'd School Impact Fee: Total $ .- <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ®rIYes El No ❑Everett School Dist ❑Mukilteo School Dist <br /> r <br /> Add'I RCW 64.55 does required prior to final? Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 2-4i000 <br /> Approved By:G14104, r O Date: N[ bd 20,1. <br /> PUBLIC WORKS <br /> Intake OK by: . Date:,,1/0 0 k17,0 <br /> Additional Notes: temp.. OF UUR RAtLy� Intake Comments: EPW Worksheet Needed if: <br /> Ei IOSys Dev Eval DTraffic Mit Eval <br /> 1 s OSite Work or Drainage Proposed <br /> Approved By: '7 Date: IJI,/ 4044t— OBackflow Prevention for high hazard: <br /> i(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: 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 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 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: V Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: ' M ,rU�2h'Y>1.BI/l(� kD 1b,Iv <br /> pp z — <br /> A roved By: Date: Approved By: U Date: <br />