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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) S PERMITS 2ooe MI <br /> ' BUILDING - PLANNING <br /> Intake OK by: Date: Intake OK byr-.7s Assign To: Date: '''•\Z• <br /> Intake Comments: Intake Comments: <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 /> BI I/ ddn/Rem Size 3 2 ..5* , F 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,A04 Zone c< S <br /> Number of Stories / Overlay/Agreement <br /> Basement '�S,No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction 1 6 Residential Use Is/VA\.\ — 0N{\y <br /> Occupancy Group 5/A 3 Proposed No.of Dwelling Units: J <br /> Occupancy Load /Z..9 Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final?, Yee. ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: A $ <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 No ❑Everett School Dist �Mukilteo School Dist <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes o Additional Notes: <br /> VALUATION CALCULATION: Total$ ,7.cO4 Oa <br /> Approved By: .- Date: ?Y,2.I2.(i1 Z <br /> PUBLICWORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> c <br /> \^\J 1?At <br /> ) ,� ' I IOSys Dev Eval ❑Traffic Mit Eva! <br /> �I j/� I OSite Work or Drainage Proposed <br /> �, ,, i <br /> Approved B . ,,,,,„„/ Date:/��`//to20 '�Backfiow 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/Deferred Submittals Required: DThis project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: IX This Permit is Approved by Public Works <br /> Imo.See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 121 A Separate PW Permit is Required(Permit#: PW 100E "co-t ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Fi 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 /> Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Ka,„, Date:8 5 ,2e 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: PiCki Date: tO fol I az <br /> 2EFz._ <br />