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Intake &Approval Sheet •OR PERMIT STAFF ONLY) •PERMIT# 2-1 A�0�'7— <br /> BUILDING . . . PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <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 ElOK to Route to Other Departments <br /> BI6/YI/c ddn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone MO <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use . 61-"i G C. ,}is}-:.) <br /> Type of Construction • /J7 Residential Use <br /> Occupancy Group /3 Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers:TiaUpdate Existing ❑New System ❑Not Req'd PlanninglLandscape Inspection Required before Final? ❑Yes 9No <br /> Reason Sprinklers Required: "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? ❑Yes El No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ElNo Additional Notes: )n ky-- tjog, alj <br /> VALUATION CALCULATION: Total$ SDI. Dv <br /> Approved By: IL Date: q. i.Z,' <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: jPW Worksheet Needed if. <br /> DSys Dev Eval DTraffic Mit Eval <br /> El Site Work or Drainage Proposed. <br /> Approved By Date: (f/�� Lpy I❑Backflow Prevention for high hazard: <br /> // / :(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> - . FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Fire Sprinklers Fire Alarm ❑Other: AND ❑Create Green Folder OSubmitted Previously ['Deferred <br /> Additional Notes: .. • ❑This Permit is Approved by Public Works <br /> A/D f /u-a ) ❑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 /> 0 Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/In.•ection Scope-ADD FIRE FEE CIWill be Issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved :JINN 4-.? 2 - Date:D11l`ZO"1/ El Public Works has no scope--- PW Not Required <br /> / Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2/a <br />