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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# p '{ r,_04 71 <br /> py 'BUILDING -7 PLANNING <br /> Intake OK by: P-k V\ Date: l((}I� [�DZ- - Intake OK by: , Assign To:i eSS',co. Date: IC/ZSkZZ <br /> Intake Comments: I Intake Comments: <br /> Corr•ec.r or\ leaner Seri- & re ciuesi-ea, ADO <br /> a? Cat•lor-I rnai er;a\s. Correc. tons Shouldn`+ <br /> Irvnpuck over-al\ de s'tcjr-, so o•W,er• revLews OK a-' <br /> r'oceed• <br /> ❑ Route to Commercial Building LI Attach to Project No.lR h V I Z 3-0 2 Z <br /> Joute to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit El OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> GaracvWc essory Struct.Size 7-q Zone g--Z. <br /> Number otStories-- 1 Overlay/Agreement 1414hlr, Al A & ACA <br /> Basement ig1No ❑Yes, Fin/Unfin Nonresidential Use lJ/A <br /> Type of Construction Residential Use SFR +A fl V <br /> Occupancy Group Proposed No.of Dwelling Units: I _ <br /> Occupancy Load Total No.of Dwelling Units: Z. <br /> Fire Sprinklers: ❑Update Existing El New System EZIot Req'd Planning/Landscape Inspection Required before Final? ❑YeNNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System EiNot Req'd School Impact Fee: Total $ k10 SChoul Sees <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 docs required prior to final? ❑Yes MNo Additional Notes: ►?ev'Lsea g` . p(a`n ;n Ne, <br /> VALUATION CALCULATION: Total $ 1Q2.7?-2. Pplrk Fee .Si/4B%Z. <br /> Approved By/- ----> Date:03 f zz/z3 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: AAcikez 2 t, of J'ArJDpAc ,R Intake Comments: 1PWWorksheetNeededif: <br /> 'HOME-Ctit_Y I('Sys Dev Eval Traffic Mit Eval <br /> 'PSite Work or Drainage Proposed <br /> Approved By: APO Date: -2.13 7.4 [❑Backflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary,hospital, <br /> {supportive housing) <br /> FIRE DEPARTMENT El 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 /> El Fire Sprinklers ❑Fire Alarm El Other: AND ❑Create Green Folder ❑Submitted Previously ['Deferred <br /> Additional Notes: IZ1 This Permit is Approved by Public Works <br /> ry See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: EA 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 ❑ 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 /> r� � <br /> Approved By: `\ .<-ni,l}n, Date: I a p „G,2 ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: <br /> Approved By: Date: Approved By 1 Date: -31 2-3 <br />