Laserfiche WebLink
Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 4 PERMIT# 12 )0 I -05 <br /> BUILDING PLANNING <br /> nI� <br /> Intake OK by: Date: Intake OK by:0 Assign To:l `�-'�T' � Date:21L1202-i. <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" ermit %OK to Route to Other Departments <br /> Bldg/TI/Add Siz jh40O Aff ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size_ A/0 Zone —1 <br /> Number of Stories 2.-- Overlay/Agreement <br /> Basement 121No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction „yL!_' Residential Use POW\� Clni� j tVV1A-C, <br /> Occupancy Group e� • Proposed No. of Dwelling Units: <br /> Occupancy Load 8 Total No.of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System FINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ONew System n Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 13No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ,No Additional Notes: <br /> VALUATION CALCULATION: Total$ 90/ 060, 04) <br /> Approved By: Date: Z1-.,2.5 ZUZ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if. <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> Approved B Date:0d///ze2, ' ;❑Backflow 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 ❑Submitted 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 /> ❑ 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 Ooin 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: '1, Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: 2/$12( <br />