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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) i PERMIT# 6 Zu"/' 0 1 <br /> BUILDING PLANNING <br /> Intake OK by: P K- Date: P5[WIAv2 Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> UM -t.R <br /> ❑ Route to Commercial Building 0 Attach to Project No_ <br /> .Route to Residential Building 0 Route to Historic Reviewer <br /> ,® Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ieig, ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone _ <br /> Number of Stories t. Overlay/Agreement <br /> Basement ElNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use LA <br /> Occupancy Group . Proposed No.of Dwelling Units: <br /> Occupancy Load X(LQi Total No.of Dwelling Units: I <br /> Fire Sprinklers: El Update Existing El New System KNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes'No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System gqNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes ERNo _ Additional Notes: <br /> VALUATION CALCULATION: Total$ 09 ODO <br /> Felt 49t L -t )N. <br /> Approved By: IL. 6 Date: et,Z . <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: _pieDate: j(1j.f 2,0ZZ. IDBackflow Prevention for high hazard: <br /> =(dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT 0 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: ❑ This 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 /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 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: I% 'ublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: '�— OS'24/14)i <br /> Approved By: Date: Approved By: Date: <br />