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411° <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# P,W OO I---e)t <br /> BUILDING / PLANNING <br /> Intake OK by: Date: (//2//Z' Intake OK by:, Assign To:ff- Date:) /2412-0 <br /> Intake Comments: Intake Comments: V <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> gq Route to Residential Building ❑ Route to Historic Reviewer <br /> ® Make this a"W"Permit I;VOK to Route to Other Departments <br /> Bldg/TI/Add C Size 4S S,c 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone ¢.-- I <br /> Number of Stories ( Overlay/Agreement <br /> Basement CI No ;Sr Yes, in Unfin Nonresidential Use <br /> Type of Construction 'fig Residential Use t <br /> Occupancy Group all,/ Proposed No.of Dwelling Units: <br /> Occupancy Load - Total No—of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System IONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes o <br /> Reason Sprinklers Required: "In Lee:Type: ___.—)Amount$ ✓✓✓✓✓✓, '' <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd School Impact : Total <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Everett ool Dist 0 Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 4KI-No Additi nal Notes: <br /> VALUATION CALCULATION: Total $ .72137t <br /> /60 @7/ <br /> 6,0 C7/ Approved By: U" Date:(O/3C/2_43 <br /> 1O©Cl/ PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 2,0 f 5' HZ e igrge. Intake Comments: IPW Worksheet Needed if: <br /> i❑Sys Dev Eval ['Traffic Mit Eval <br /> i❑Site Work or Drainage Proposed <br /> Approved By: Date:/' / � _❑Backflow Prevention for high hazard: <br /> ...c6„...7/16 ' / _ =(dental,medical,animals,mortuary,hospital, <br /> i supportive housing) <br /> FIRE DEPARTMENT - El 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 /> DFire 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 0 Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folderfor 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: RI-Public Works has no scope--- PW Not quired <br /> Additional Not • <br /> p? ica Izo rx, <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />