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IP r <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#8(A2Z00?-008 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: lit Assign To:-.1-�(, Date:',/ lt2G) <br /> Intake Comments: Intake Commen / / <br /> p ii <br /> I <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building Route to Historic Reviewer <br /> ❑ Make this a"W"Permit K to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 1' Z —r--t't Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone 2 .-3 <br /> Number of Stories a- Overlay/Agreement <br /> Basement V]No ❑Yes, Fin/Unfin Nonresidential Use .-- - <br /> Type of Construction V ' Residential Use rYW .1 ➢ 64,11 <br /> Occupancy Group ft-2- Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: -.—.-- <br /> Fire Sprinklers: ❑Update Existing ❑NewSystem gi Not Req'd Plannin andscape Inspection Requi before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fee: Amount$ JJJ______ <br /> Fire Alarm: ❑Update Existing ❑New System W Not Req'd School Impact Fee: o <br /> Reason Fire Alarm Required: Calculated: edit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No 0 Everett ool Dist ❑Mukilteo Sch • t <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additio I Notes: <br /> VALUATION CALCULATION: Total$ j,#I <br /> h � n,� <br /> Approved By: ft..,4 <br /> '2 Date: I \'71 I W PUBLIC WORKS <br /> Intake OK by: Date: • <br /> Additional Notes: 4. e,4At.=A= v.WD�R.►rt 1 repIntake Comments: PW Worksheet Needed if: <br /> k/012K --no (�ILeCere AO apple-riaaiaz, ft-Prpom. IOSys Dev Eval DTraffic Mit Eval <br /> IN A.ld E'tcAsm,rtt S- 4 tr. yfD c- .R,tE.tj-rp cei-G141, rot 1OSite Work or Drainage Proposed <br /> Approved By: Date: if ip°t OBackflow Prevention for high hazard: <br /> ' a(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 OFire Alarm ❑Other: AND El 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 /> ig Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: rbGJ Date:s-y,2a2o AU-Public Works has no scope PW Not Required <br /> Additional Notes: / <br /> ELECTRICAL of a¢lam <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2/� <br />