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Intake & Approval Sheet (FOR PERMIT STAFF ONLPERMIT# °1 O <br /> Y) "l.- /`1T' <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TC/Addn/Rem Size I Cy dg ---k- in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone C. <br /> Number of Stories d Overlay/Agreement <br /> Basement ODNo ❑Yes , Fin/Unfin Nonresidential Use N'nAAACt&t �hS\\�: �i0NN <br /> Type of Construction Vrj Residential Use <br /> Occupancy Group '' Proposed No.of Dwelling Units: <br /> Occupancy Load t Total No.of Dwelling Units: <br /> Fire Sprinklers: IKIUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Re• ' ed before Final? ❑Yes VINo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: IMUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Tot- '. <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No El Everett Schoo list ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IINo Additional N• -s: <br /> VALUATION CALCULATION: Total$ 1-3f sa3 <br /> Approved By:�'n. 2 Date: 5", VA.1JJ\ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: /¢,m/l�f ❑Backflow Prevention for high hazard: <br /> I (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> E FIre Sprinklers lire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <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 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> in Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: j1.BYae...,./h Date: s�EP-/9 IN Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: , <br /> Approved By: Date: Approved By: s*J(N' ,,,v Date: /2'L <br />