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110 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# L G)S <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:a4 Assign To:01.644... ri)(01202-1 <br /> fl <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Ro to to Historic Reviewer <br /> ❑ Make this a"W"Permit K to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size j D •=1-1 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size EyDO 1)-/# Zone 1� <br /> Number of Stories / Overlay/Agreement <br /> Basement LVNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Z2C Proposed No.of Dwelling Units: <br /> Occupancy Load 8 Total No.of Dwelling Units: <br /> Fire Sprinklers: DI Update Existing ❑New System 'MNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System ZlNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I�s�No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 does required prior to final? ❑Yes ,®No Additional Notes: <br /> VALUATION CALCULATION: Total$ 3 j de=0 O <br /> Approved By:(4) Date: 1 I/('12o2-'t <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Intake Comments: €.._�.,__.._.W.,_........,..._.__.,�..,_.,.,__..,.�.,.,._.,.,.__,. <br /> Additional Notes: EPW Worksheet Needed if: <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> £DSite Work or Drainage Proposed <br /> Approved By Date: /g�Z 7Aepz( ]Backflow 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(loin 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: Date: Public Works has no scope---PW Not Required <br /> d itional Notes: <br /> ELECTRICAL IJo f,Or 00i(K 0v f <br /> Additional Notes: �l <br /> Approved By: Date: Ory 'By: Dater (a(2,10 z t <br />