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1111 <br /> Intake &Approval Sheet 410 (FOR PERMIT STAFF ONLY) PERMIT# 13 22 0 4 — a 1 a/ <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK byDrYk. Assign To: Date: 1IV-7 <br /> Intake Comments: • Intake Comments: <br /> • <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone 17=17c)( k_ <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Chew System ❑Not Req'd ' Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing❑New System ONot 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? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ C.Q 3'i ° e 1 ZlitjAY10(6-14A-6e q/14 -7-- <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: iPWWorksheet Needed if: � �- -W <br /> LISys Dev Eval ❑Traffic Mit Eval <br /> i <br /> _DSite Work or Drainage Proposed <br /> Approved By: \�� Date: .4. �J ZQ- _UBackflow Prevention for high hazard: <br /> Q • :(dental,medical,animals,mortuary,hospital, <br /> !supportive housing) <br /> PP <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet - <br /> Separate/Deferred Submittals Req ' d: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> e <br /> DFire Sprinklers ❑Fire Alarm then AND ❑Create Green Folder OSubmitted Previously ❑Deferred <br /> r ( <br /> Additional Notes: This Permit is Approved by Public Works <br /> Ki.i.c. . O 8./ktoe ❑ See PW Review Worksheet and associated attached items Oft <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 /> 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 i4L.tr-o(2l) Date: f?4/7 2. ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: Pwvrry ( Q uls+cTh -fil <br /> ELECTRICAL IZTArnaVt kS `(II Qy p e£ . <br /> Additional Notes: 1�� <br /> Approved By: Date: Approved By: )5? Date: /aglenyrt_ <br />