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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0 kROtA —00c <br /> BUILDING / PLANNING <br /> "�`/ <br /> Intake OK by: Date: f/i //9 Intake OK by: 3VV..L Vb\VA Date: L\• J\• tO\cj <br /> Intake Comments: Intake Comments: Assign To: � 'VOA\ard <br /> N e-e& N``M c \6► c,E"\J I PQ;d <br /> • JazAcizgcgieu*-0/v .A.kcit,-y <br /> o Route to Commercial Building 0 Attach to Project No. <br /> aRoute to Residential Building ❑ Route to Historic Reviewer - <br /> p <br /> ❑ Make this a"W" Permit ® OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 73 7 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 75 3 s,. Zone - <br /> Number of Stories Z. Overlay/Agreement <br /> Basement JNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction :YE Residential Use SF{&- A- ‘OAL‘U\ <br /> Occupancy Group Proposed No.of Dwelling Units: CYAN:Q <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes KNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System DNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: ^ Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑``Mukilteo School Dist s"� <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: ��� �Cq`)WS �MPC�.t lebv,;�d, ‘14.vNtel <br /> VALUATION CALCULATION: Total$ Z�! <<3/S `---rok•• - - hA <br /> ..lows.IMILIMMOPIIL W. <br /> -727 " /Z/ t i(77 Approved By: - Date: C‘.0Ck. 2O\ 1 <br /> IS,2 F ire, 3Y 6 7f PUBLIC WORKS <br /> Intake OK by: j.J Date: -4 ( + J t `-t <br /> Additional Notes: 2Q`..s ii-- costs.--G_ Intake Comments: PW Worksheet Needed if: <br /> RJES7 C-7�-K! 7U / ee,p2tJQ r4 4 qp �p4,44, -v-) hAs.i4cAc ? A"J Sys Dev Eval ❑Traffic Mit Eval <br /> Eifbea -t iQU/146c ot)IMAK. Afrg.jy,,{{� O 46.Q- ?'F ii Lk_ 4904 4.0 g9ite Work or Drainage Proposed <br /> i 1L�`� �� ?4,-- ❑Backflow Prevention for high hazard: <br /> Approved By: Date: `T - 192 0 N c_ NN►ae� (dental,medical,animals,mortuary,hospital, <br /> -G'' i)(4.4.- 6,boSiirc...C. 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: 0 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 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: Date: 57 /` <br />