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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# '2CO2 O I Jo <br /> BUILDING PLANNING <br /> Intake OK by: Date: t� � Intake OK by: Y-- Assign To: Y.� Date: 2— 2,—nto <br /> Intake Commen4,, <br /> Intake Comments: <br /> QJML) - (QA co AcrAev Le---i innyeenn <br /> tom h C w a._ <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ►: •K to Route to Other Departments <br /> Bldgfil/Addn/Rem Size W.- - II Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone 6r1 0 <br /> Number of Stories Overlay/Agreement <br /> Basement JNo ❑Yes, Fin/Unfin Nonresidential Use ag-iy2_ <br /> Type of Construction \L i; Residential Use <br /> Occupancy Group g Proposed No.of Dwelling Units: <br /> Occupancy Load — Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing CI New System E5a Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes If <br /> No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ /// <br /> Fire Alarm: CI 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 I No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: lipi <br /> CS .^_�(��CD�e l 041113 <br /> VALUATION CALCULATION: Total$ I S Uob r <br /> Approved By: J`ski Date: 9— 13— c <br /> . PUBLIC WORKS <br /> Intake OK by:G/� �'7J T Date: �-1I <br /> (` i e.o zt <br /> Intake Comments: PW Worksheet Needed if: <br /> Additional Notes: <br /> 22�pat k wav s .oM <br /> v£h4t yttz 'net►KtiLzt�- 't fi s�.a�,pe i❑Sys Dev Eval ❑Traffic Mit Eval <br /> V tJ - QSite Work or Drainage Proposed <br /> Approved By: yrf2, Date: � L( 2r ❑Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> isupportive 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 ODeferred <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 ) <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 /> i <br /> Approved By: Date: 5��'ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: - Date: ell 11,1Earl/ <br />