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Intake & Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT# 6 22f3 O OiDi <br /> BUILDING PLANNING <br /> Intake OK by: VAY Date: 46 V \21---- Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ,Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"11�Permit ,( El OK to Route to Other Departments <br /> Bldg/TI/Add /Rem Siz 9 6 6 4p El Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size I Zone <br /> Number of Stories 2— Overlay/Agreement <br /> Basement ❑No l.Ye Fin Unfin Nonresidential Use <br /> Type of Construction Residential Use cj' t_., <br /> Occupancy Group T Proposed No.of Dwelling Units: <br /> Occupancy Load 1e--C Total No.of Dwelling Units: 1. <br /> Fire Sprinklers: El Update Existing ❑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: DUpdate Existing ❑New System n-Not Req'd School Impact Fee: Total $ _ _ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes EirNo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes 'No Additional Notes: 1,\ 1?� - ('.f,,' s <br /> VALUATION CALCULATION: Total $ 5OC-1) Qkt:4+ Oi3 tip / <br /> Approved By: L;qi <br /> Date: l� j,ZZALIC WORKS <br /> Intake OK by: T- Date: <br /> Additional Notes: p _ Intake Comments: PW Worksheet Needed if:• <br /> Gc t UtU '`Tree) , G_...es... O 0-i L- I ElSys Dev Eval ❑Traffic Mit Eval <br /> G�O(2.- zi3 a: ic ) ...to -9,4 s Gibe� ❑Site Work or Drainage Proposed <br /> Approved By: f_P Date: leg -4,67 Z.r ❑Backflow Prevention for high hazard: <br /> l(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 /> El Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create 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 ❑ 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: 'Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: � 'I. koi.'_ <br /> Approved By: Date: Approved By: Date: <br />