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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# � OfJ <br /> BUILDING PLANNING <br /> Intake OK by: Date: 4/ - / /�-o2✓ Intake OK by: t Assign To: S Date: l�.y l 1�`� <br /> Intake Comment_ : Intake Comments: <br /> • <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 iaa, 64- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size -- Zone t—I <br /> Number of Stories t Overlay/Agreement <br /> Basement DkNo ❑Yes, Fin/Unfin Nonresidential Use ii%),. ..t..STTZ,A L— <br /> Type of Construction -tcr -- Residential Use <br /> Occupancy Group " 'I_ Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing CEINew System [hot Req'd Planning/Landscape Inspection Required before Final? . Yes ❑No <br /> Reason Sprinklers Required: 5. C..e C) . . "In Lieu"Fee:Type: s Amount$ <br /> Fire Alarm: ❑Update Existing JNew System ❑Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: 7 n Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes PL No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 does required prior to final? ❑Yes MNo Additional Notes: <br /> VALUATION CALCULATION: Total$ S,tOp I ta`t?, -o �` rAt PST <br /> �o ( Ito ) t= 1l Ss000 <br /> 1 r. Co Z '4 e = Approved By` —� Date: /0 <br /> Ib, '2 ll+F n O,S <br /> S�a 1 coRR,z� PUBLIC WORKS <br /> ' Intake OK by: . Date: <br /> Additional Notes: � E -� ( Intake Comments: 1.PW Worksheet Needed if: ,. 1..,...,,.,,.....- -� <br /> 1USys Dev Eval ElTraffic Mit Eval <br /> °OSite Work or Drainage Proposed <br /> Approved By: Date: iptj$/, 12— �Backflow Prevention for high hazard: <br /> i `` I(dental,medical,animals,mortuary,hospital, <br /> `supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: OThis project also has a separate concurrent PW Review(Green Folder) <br /> caFire Sprinklers Z.Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> .See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: • -A Separate PW Permit is Required(Permit#:PW ILA 12-'0 2 4 ) <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 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: it5cO(,J.(\ Date:5.j 0-- ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B . Date: *iv? 2a 2Z <br />