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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# SC2?0210E--l°6 <br /> BUILDING • PLANNING • . . <br /> Intake OK by: c Date:10 1421- Intake OK by Y1 Assign To: Date:g17,070 7 . <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> 'IS Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ',/E✓ t5IF- ElHold in Planning File Drawer <br /> Garage/Accessory Struct.Size it--% Zone 1Z- <br /> Number of Stories J� Overlay/Agreement - <br /> Basement filNo DYes , Fin/Unfin Nonresidential Use <br /> Type of Construction /2l Residential Use <br /> Occupancy Group ,r,4...4 Proposed No.of Dwelling Units: . <br /> Occupancy Load ^L� Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ONew System ,Mot Req'd Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Reason Sprinklers Required: � "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑ in Not 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? DYes ® No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? DYes 'No Additional Notes.'7(LY \cr\�^2LC+--eCt✓ 2 ixdr tryiS <br /> VALUATION CALCULATION: Total$ /rJ/ TOn,DO I I,SEi Z I /�� KU' �0 fqf' 7� <br /> 4 01, : / a1� 1;� <br /> Approved By: Date: <br /> IC 5/soo. o,, PUBLIC WORKS' <br /> Intake OK by: I-Psi Date: 8 /'L 9 1 1--u z L <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if. <br /> ( ' sv1G�C Si S{'r "� Ajr yDev Eal ❑Traffic'Mit Eval <br /> — p.o, - ,A.L� Avi)... s.s 1 ESite Work or Drainage Proposed. <br /> Approved By� 14 Date: /( ice^ ,� rzx- .r la.; ]� Backflow Prevention for high hazard: <br /> ✓� i (dental,medical,animals,mortuary,hospital, <br /> PL Igo5-033 supportive housing) <br /> FIRE DEPARTMENT MRoute 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 DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: !; lill This Permit is Approved by Public Works 1 <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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:\< QfO(,L.) Date: IQ -( \ ; 0 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By:-) j jj4 tt Ap� Date: 1\)4) t2i <br /> v -4, <br />