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Intake & Approval Sheet ,'FOR PERMIT STAFF ONLY) PERMIT # D -7/Z 0_� — D 1 -C) <br />BUILDING <br />Intake OK by: OIL& Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />d /TI/Addn/Rem Size <br />(-7 4 LA <br />Garage/AccessoryStruct. Size <br />Number of Stories <br />Basement <br />gNo ❑Yes , Fin / Unfin <br />Type of Construction <br />' t4 <br />Occupancy Group <br />ZW <br />Occupancy Load <br />&P-C <br />Fire Sprinklers: El Update Existing El New System qNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ONot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes fNNo <br />VALUATION CALCULATION: Total $ '2A I <br />Additional Notes: <br />Approved By: ! Date: ((j�'2 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: d,A2 <br />Intake Comm . <br />Some M;nor, GorrerJionS needed, but- no}h•,nc� <br />�Ywk <br />W',11 s�yr,;�-ican4ly alter the design, so reviews <br />40rn <br />o; ner deptS. OV. +0 move TOrW G1d . <br />® Attach to Project No. REV 122 <br />❑ Route to Historic Reviewer <br />® OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />N/A <br />Nonresidential Use <br />1J/A <br />Residential Use <br />S <br />Proposed No. of Dwelling Units <br />6 2 on lo} <br />Total No. of Dwelling Units: <br />p lP 2 or kot <br />Planning/Landscape Inspection Required before Final? ❑Yes ®No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit:_ <br />El Everett School Dist J�Mukilteo School Distl I, 121 • OU <br />Additional Notes: ge-e-As but\d',n(� he;9h� calwly}Ions <br />2027 park iree.-. � 2 1 ` Z3.CU 0°b�•� <br />Approved By:JeSs1C JQrYt r Date: <br />PUBLIC WORKS <br />Intake OK by: ' ' Date <br />_........................... .,....._..-..........................__._.._ <br />Intake Comments: ?PWWorksheet Needed if. • <br />_S CAE- `e Z Lo _1 ' o 7-3 ' ElSys Dev Eva[ FiTrafric Mit Eval <br />23de Work or Drainage Proposed <br />E ❑Backflow Prevention for high hazard: <br />[(dental, medical, animals, mortuary, hospital, <br />{supportive housing) <br />i.....................................................................................................,,,....,...........................,......._.._... <br />DRoute this folder for PW Review at end --- PW Review Worksheet <br />OThis project also has a separate concurrent PW Review (Green Folder) <br />AND aCreate Green Folder ❑Submitted Previously ❑Deferred <br />M This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />2 <br />A Separate PW Permit is Required (Permit #: PW ZZb1�02� ) <br />AND ❑ Is located in this folder <br />5 Is in a Separate Green Folder Coin with this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved B <br />Date: Ot <br />103126 <br />a <br />