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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) . PERMIT# 6 2-7.--0 4_0A;' <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: 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"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /VJJ/A Zone <br /> Number of Stories 1 Overlay/Agreement <br /> Basement EiiNo ❑Yes, Fin/Unfin Nonresidential Use (Am\ I s l c_ <br /> Type of Construction 40 VQ Residential Use <br /> 7 <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes PIo <br /> Reason Sprinklers Required: S "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: gh, ;5T Z i✓lr g Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 does required prior to final? ❑Yes No Additional Notes: , 05e- _or- <br /> VALUATION CALCULATION: Total$ %) D r?L,00 naA j,q 1 t-5 <br /> i <br /> am,A__ <br /> Approved By: }C.. Date: q. ?to.'ZZ <br /> UBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: =PWWorksheet Needed if: <br /> OSys Dev Eval OTraffic Mit Eval <br /> =OSite Work or Drainage Proposed <br /> Approved B Date fj/�thea....-IE:cy..e._..717Z-, <br /> `OBackflow 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/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 /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#: PW ) <br /> PiReview of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> jvlinimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> , iew/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> , <br /> Approved By: e,cnc Q - �-;,Date: 0/L24 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />