Laserfiche WebLink
Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 5 2,?1:1L0"02M <br /> BUILDING, PLANNING <br /> Intake OK by: g<<< - Date: ' //S ?iOZZ Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> BflSentt:n-'T aprvt/ 12stan) <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ 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 ?OS sr-. ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone V-_2__ <br /> Number of Stories 2- Overlay/Agreement <br /> Basement ❑No ®Yes, in Unfin Nonresidential Use <br /> Type of ConstructionC Residential Use .jZ <br /> Occupancy Group ../gZ Proposed No.of Dwelling Units: <br /> Occupancy Load - Total No.of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing ❑New System ,191.1ot Req'd Planning/Landscape Inspection Required before Final? ❑YesX1No <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 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? Cl <br /> No Additional Notes: <br /> VALUATION CALCULATION: Total $ /2/ DBO <br /> Approved By: V- .4-?- 0 Date: _Z 2-77,_ ` <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: /2,L , Date:/4//8/2422._ 10Backflow 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 /> OFire 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 /> 0 Minimal or No Fire Scope-NO FIRE FEE 0 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/PLUMBING <br /> -- <br /> Additional Notes: __ -.L ,_ / <br /> ,_,( 061///2o21.. <br /> Approved By: Date: Approved By: Date: <br /> L <br />