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410 <br /> Intake &Approval Sheet (FOR •PERMIT STAFF ONLY) PERMIT# Blo10 <br /> -'0-14cj <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: at Assign To:[h-1S r: Date: I dl2-?/2 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ElAttach to Project No. W \ T LC)r 6 k2 <br /> ❑ Route to Residential Building ❑ ute to Historic Reviewer <br /> El Make this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 7C84- Zone p.—Z <br /> Number of Stories i Overlay/Agreement <br /> Basement allo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction V—Z3 Residential Use S <br /> Occupancy Group LI Proposed No.of Dwelling Units: <br /> Occupancy Load / Total No.of Dwelling Units: <br /> Fire Sprinklers: CI Update Existing ❑New System BNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System INNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No DEverett School Dist ❑Mukilteo School Dist <br /> q <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ C. > Kt( <br /> Approved By: I l r 0 Date: 1,0 1?-1 Igoe <br /> K ‘-e el_________O ,„ <br /> PUBLIC WORKS <br /> 3C 1 -� Intake OK by: Date: <br /> Additional Notes: Intake Comments: 'PW Worksheet Needed if: <br /> I DSys Dev Eval ❑Traffic Mit Eval <br /> Site Work or Drainage Proposed <br /> Approved By: Zr Date: /Q 07 DBackf ow 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 El Fire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 11 This.Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: JA Separate PW Permit is Required (Permit#: PW 2 0 12'0 11 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND C 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: AP'6 Date: ZD cl 1 2,0 <br />