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• it.t�� <br /> Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 'PERMIT# .QD Z2os-- oS i <br /> BUILDING ��jl PLANNING' <br /> Intake OK by:L Date:5140 Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> C1 Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ M/,c,�e this a"W"Permit El OK to Route to Other Departments <br /> Bldg\ddn/Rem Size Yc ff it ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone yV <br /> Number of Stories f Overlay/Agreement <br /> tesI Basement No ❑Yes, Fin/Unfin Nonresidential Use . tece c,'DA / <br /> Type of Construction • i f• Residential Use <br /> Occupancy Group E Proposed No.of Dwelling Units: <br /> Occupancy Load /o?d • Total No.of Dwelling Units: <br /> Fire Sprinklers:gUpdate Existing ❑New System ONot Req'd Planning/Landscape Inspection Required bef•re Final? ❑Yes 1;;rNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ❑New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: l Ad ,etozi.,— Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes la No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yees 12No Additional Notes: ,"n v p (y ,L4\1 <br /> 1�E <br /> VALUATION CALCULATION: Total$ i% 0200)0O 't 1 ++S�v 3 KX <br /> Approved By: .4\ i 5-1., Date: 6,24.Z2,., <br /> PUBLIC WORKS, <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval DTrafficMit Eval <br /> , ❑Site Work or Drainage Proposed <br /> Approved By`/'/ Date:w DBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> _ FIRE DEPARTMENT El Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate 1 Deferred Submittals Required: ['This project also has a separate concurrent PW Review(Green Folder) <br /> 121Rre Sprinklers ,Fire Alarm El Other: �AN(D OCreate Green Folder ['Submitted Previously ['Deferred <br /> Additional Notes: Jed This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items NIA- <br /> Fire Dept.Fees: El A Separate�.��// PW Permit is Required(Permit itPW�ZOS—053 ) <br /> El Review of As-Built Plans-NO FIRE FEE AND 1�79.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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K 41301r oyk Date:5- ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: n f c <br /> T� '�Y ��wd1r�. /VO td/MitM.al <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: r.h Date: 5/23-� Z, <br />