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Intake &Approval Sheet (FOR PERMIT STAFF ONL r PERMIT# LJ 7/�0 �J J 0�5 <br /> BUILDING PLANNING p <br /> Intake OK by: K-- Date: intake Intake OK by: Assign To: Date: -) <br /> Intake Comments: Intake Comments: \J <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 ❑ Hold in Planning File Drawer <br /> Garage/AccessoryStruct.Size #5Z Sr- Zone <br /> Number of Stories 2 Overlay/Agreement <br /> Basement ONO ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction J_fA Residential Use <br /> Occupancy Group .Yz Proposed No.of Dwelling Units: <br /> Occupancy Load X-F,C Total No.of Dwelling Units: CeQ 3 <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONO <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amou <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes K"No []Everett School D ❑Mukilteo School Dist <br /> Add1 RCW 64.55 does required prior to final? ❑Yes ONO Additional s: <br /> VALUATION CALCULATION: Total$S8, 75 Z <br /> 12-x 3(a = '132- SF <br /> Zo )c 3Zo =? SF Approved B Date: �� 041 <br /> l/5 ZS1= PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PWWorksheet Needed if. <br /> - <br /> 4�56 t AV'► W ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Q{ 6 4 6jA++&4tY6t14rA1 }❑Site Work or Drainage Proposed <br /> Approved By: Date: 0Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> v% supportive housing) <br /> FIRE DEPARTMENT ❑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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder []Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> Ef See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: IR A Separate PW Permit is Required (Permit#: PW 2Z01'0C19 ) <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 Qoin 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: Date: ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: "�A 'TOM <br /> ELECTRICAL/PLUMBING r� � ^1i �IY1VGNl "KAI <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> �Z_ <br />