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Intake &Approval Sheet 'FOR PERMIT STAFF ONLY) PERMIT# l2 O -°d Z <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: 'Del Assign To: Jc..SS Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> BldglTl/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct,Size Zone u94 <br /> Number of Stories Overlay/Agreement Me}ro <br /> Basement DI No illYes, Fin/Unfin Nonresidential Use Qc.t'.b vS f11. <br /> Type of Construction V-A Residential Use <br /> Occupancy Group 4—I Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Mew System t]Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes , No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$0 <br /> Fire Alarm: ❑Update Existing ❑New System 6Not Req'd School Impact Fee: Total $ C <br /> Reason Fire Alarm Required: r�I Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes [� No El Everett School Dist ❑Mukilteo School Dist <br /> Addl RCW 64.55 docs required prior to final? ❑Yes 8,No Additional Notes: -- Park. .pp, 2O ZZ <br /> VALUATION CALCULATION: Total$ 15 odd o a , ?r,40,t•03s (w;I v 4...A"J — 1 tq Q,6'J <br /> (.2CD$ itc ('1 <br /> Approved By: Date: 8 (7 Z 3 <br /> PUBLIC WORKS Intake OK by: �iLc; Date:. /.G /11 .1 ZD ZZ,.,..�..,,..,,,.,..., <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> C.--pv►1.Ibi AZ 1OSys Dev Eval ❑Traffic Mit Eval <br /> gooF be Y'Y4`", i '4� DSite Work or Drainage Proposed <br /> Approved B Date:O�Z� 4� T ,� 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 /> ❑Fire Sprinklers ❑Fire Alarm El 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 ❑ Is located in this folder <br /> ❑ ' nal or No Fire Scope-NO FIRE FEE El Is in a Separate Green Folder(join with this folder for permit Issuance) <br /> Review/Inspection Scope E FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: j® ate: `O-L.22_, Public Works has no scope---PW Not Required <br /> OCh (k dditional Notes: scope-- <br /> ELECTRICAL <br /> Additional Notes:/ �" <br /> Approved By: Date: Approved Byr r . Date: IIbj1 317.40 7i?/ <br />