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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) i PERMIT# G - O rt ©,X <br /> /� r BUILDING • . PLANNING <br /> Intake OK by: es An Date: Ct ° 1�iZ Intake OK by: 'Dd Assign To: Date: 3 S14-that <br /> Intake Comments: Intake Comments: <br /> 0 Route to Commercial Building ❑Attach to Project No. <br /> la Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone Al <br /> Number of Stories `l.. Overlay/Agreement <br /> Basement InNo ❑Yes, Fin/Unfin Nonresidential Use . <br /> Type of Construction - ?(ZL Residential Use ifN <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load • • Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System "Not Req'd Planning/Landscape Inspection Required before Final? Ekes Cho <br /> Reason Sprinklers Required: ub "In Lieu"Fee:Type: NJA Amount$ <br /> ❑Fire Alarm: Update Existing ❑ r <br /> New System L'�.Not Req'd School Impact Fee: Total $ AlIp1 <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? ❑Yes I5Nlo Additional Notes: E,10 4 f `�k im,P4ct 4CZ4 - i <br /> VALUATION CALCULATION: Total <br /> !G./050 ViAS.0D <br /> Approved By: i ts i'", 4.ke6 Date: 23 It.. p t Za 2Z <br /> PUBLIC WORKS:. (.� <br /> Intake OK by: (9 Date: " I I,.u1V,,..J ' Z7i ..,...............,,,W,,,,,,,,W. <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if. <br /> " ' 4 I _. /44t ib IS iDSys Dev Eval ❑Traffic Mit Eval <br /> (2- 4(0 4Z-2— <br /> IEISite Work or Drainage Proposed. <br /> Approved By 2Q4Date: Ci/ L7Backflow 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 1 Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ODeferred <br /> • <br /> Additional Notes: ; ❑This Permit is Approved by Public Works w <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required (Permit#:PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> 2-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 /> Approved By:\<,\fb'(A), Date: I 0 —11-^2.,2 f1 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL _A -,,, <br /> Additional Notes: ,'J. i/Aot ontiVVt, aq t 1412622-# <br /> Approved By: Date: Approved BY Date: <br />