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<br /> Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT# S g-A0 S-= ((6
<br /> BUILDING / PLANNING% • • • .
<br /> Intake OK by: 14- Date: ib16[Zo2Z Intake OK by: Assign To: Date:
<br /> Intake Comments: Intake Comments:
<br /> (6) gt Ott( I'4?W PIM 14 ®nit y
<br /> App1NC', t)si-vg-490114,
<br /> ❑ Route to Commercial Building ❑Attach to Project No.
<br /> ❑ Route to Residential Building 0 Route to Historic Reviewer
<br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments
<br /> Bldg/TI/Addn em Size 0 Hold in Planning File Drawer
<br /> Garage/Accessory Struct.Size Zone
<br /> Number of Stories 2'SpL If L Overlay/Agreement _
<br /> Basement * ❑No I tYes, Fin/Unfin Nonresidential Use
<br /> Type of Construction • 1 Residential Use
<br /> Occupancy Group `� Proposed No.of Dwelling Units: .
<br /> Occupancy Load Total No.of Dwelling Units:
<br /> Fire Sprinklers: ❑Update Existing ONew System Q Not 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 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 IN No ❑Everett.School Dist ❑Mukilteo School Dist
<br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 1231No Additional Notes:
<br /> VALUATION CALCULATION: Total$ '30/00 0
<br /> Approved By: ,(/ Date:Grpc f rQli2i
<br /> . PUBLIC WORKS'"
<br /> Intake OK by: _I--_:1 Datee'...,,,,..,._..,....P!i„I.3,C.,,,,1t,.e 2.1-,,,,,,,,,,,,,,,,,,.,,,,.,,,,.,,,W.
<br /> Additional Notes: Intake Comments: 'PW Worksheet Needed if:
<br /> 1+v T•.=4 0 - �''--'' IDSys Dev Eval ❑Traffic'Mit Eval
<br /> +J' --e'' xd"''' IDSite Work or Drainage Proposed.
<br /> Approved By: ".iK. Date: /Q'6/Z42Z IDBackflow 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 /> 0 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 0 Is located in this folder
<br /> I-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. .A?-).Cr)' g\ Date: 1,0—\'-22, 1ublic Works has no scope---PW Not Required
<br /> Additional Notes:
<br /> ELECTRICAL _
<br /> Additional Notes: "� 0 i4,�bze.1 -
<br /> Approved By: Date: Approved By: Date:
<br /> L`
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