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f<-` <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# t/L6I 0---U�'J <br /> BUILDING PLANNING <br /> Intake OK by:Lfi " Date: Intake OK by: Assign To: Date:. <br /> Intake Comments: Intake Comments: <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 135a-- ' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone K. Z <br /> Number of Stories 2_ Overlay/Agreement <br /> Basement 111No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction ({..G Residential Use ;- ttc 3 Z__ <br /> Occupancy Group 1t..C. Proposed No. of Dwelling Units: <br /> Occupancy Load IKC- Total No. of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing CI New System J Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes to <br /> Reason Sprinklers Required: "In Lieu"Fee: Type: Amo t$ ,'` <br /> Fire Alarm: CI Update Existing CI 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 Cil No ❑Everett School Dist ❑Mukilteo hool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes lin No Additional Notes: <br /> VALUATION CALCULATION: Total$ l ta3/S412- <br /> Approved By: IL vi Date: .5 — (;t;,_z,i <br /> VUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: i PW Worksheet Needed if: <br /> I❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> 'fl �� i OBackflow Prevention for high hazard: <br /> Approved By: •� �(+ Date: I ; <br /> I =(dental,medical,animals,mortuary,hospital, <br /> I 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: AN ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: is Permit is Approved by Public Works <br /> „pee PW r '(ew Worksheet and associated attached items <br /> r <br /> Fire Dept. Fees: .Se' J PW Permit is Required (Permit#: P`^ _) <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(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE i ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> r <br /> Approved By; ,�>rO(.vYl Date: 5 rj:� - - .hlic Works has no scope--- PW Not Required <br /> Additional Notes: ALL VE5 Fa_ <ORM tij ' <br /> ELECTRICAL /�, � Q() 1 .IO p .I ki,�1- r5, 0514. <br /> Additional Notes: ►J` /�► <br /> Approved By: Date: Approved By: 1 Date: m. <br /> /z- <br />