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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# "?2Z \ L^ t 40 <br /> BUILDING PLANNING <br /> Intake OK by: 11/ Date: I I z5 - Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> VrxiMood films l - re .e_es 14,-, <br /> - VIZ f0/11— V7e12)5) '''' <br /> .-- I on_ <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> 111 Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/Tl d e l r 3- 5 F ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone ! l <br /> Number of Stories 'j.. Overlay/Agreement a <br /> Basement ISINo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction s Residential Use Art,1A ,,,„ I <br /> Occupancy Group •fiZ Proposed No.of Dwelling Units: <br /> Occupancy Load -19--C-- Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? Dyes L�INo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System 12.Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Dyes BNo Additional Notes: <br /> VALUATION CALCULATION: Total$401) c167/ 72 <br /> C 6-- Ce v/2S'L 1i il <br /> '7'''I 1 S F Olt 3Q'F = '762 7Ze): <br /> Approved By: y_'`1 Date: '3146 ZZ <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: \ =PW Worksheet Needed if: <br /> PtAl ct n. - tr QYMIA11 1/4Sys Dev Eval ❑Traffic Mit Eval <br /> • & Stets �� b ElSite Work or Drainage Proposed <br /> Approved By: r�,lL - Date: 0l f I3/ZaZ3 L� - pp Ili; OBackflow Prevention for high hazard: <br /> {4JE �v\ ' t(dental,medical,animals,mortuary,hospital, <br /> -Skortiv ;supportive housing) <br /> FIRE DEPARTMENT 1 Route this older for PW Pkeaw 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: iffThis Permit is Approved by Public Works <br /> N,See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ,B,A Separate, PW Permit is Required (Permit#:PW ) <br /> Elpa <br /> Review of As-Built Plans-NO FIRE FEE AND Ll 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 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 /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved Date: 41 Se,lz L Z + <br /> 2—i -L <br />