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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# 92 I of-V"J'7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by# Assign To: Y-,.e. Date:21212a I <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2 Tf6- '/A Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone 111V <br /> Number of Stories f Overlay/Agreement <br /> Basement EINo ❑Yes , Fin/Unfin Nonresidential Use VOAAOUCe/ierffiGe, <br /> Type of Construction V` 13 Residential Use <br /> Occupancy Group S 1 /.' Proposed No.of Dwelling Units: <br /> Occupancy Load 1 0/\ Total No. of Dwelling Units: -------- <br /> Fire Sprinklers:t!Update Existing QNew System l Not Req'd Planning/Landscape Inspection Required befor nal? ❑Yes ❑No <br /> Reason Sprinklers Require,_y " - "In Lieu"Fee:Type: mount$ <br /> Fire Alarm: )2Update Existing Lliew System 6Not Req'd School Impact Fee: Total $ <br /> p Reason Fire Alarm Require': � y Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ' No I ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? oyes inNo Additional Notes: <br /> VALUATION CALCULATION: Total$ J5r< <br /> Approved B ,- � Date: 1... tsz21 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> -OSys Dev Eval ❑Traffic Mit Eval <br /> i <br /> , I❑Site Work or Drainage Proposed <br /> 1 /� �'/O e� ❑Backflow Prevention for high hazard: <br /> / <br /> Approved By: Date: L ' (dental,medical,animals,mortuary,hospital, <br /> FIRE DEPARTMENT ❑Roui._ rksheet <br /> Separate/Deferred Submittals Required: ❑This been Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other. AND C )eferred <br /> Additional Notes: CI This <br /> ❑ See (13 S <br /> Fire Dept. Fees: ❑ A Se ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND <br /> "Minimal or No Fire Scope-NO FIRE FEE C ,it issuance) <br /> p p — —ed ahead of Bldg) <br /> ❑ Review/Ins Inspection Scope-ADD FIRE FEE f <br /> Approved By: Date: /�j,/�l ❑ Publi <br /> ddd Addition,ELECTRICAL <br /> G' <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 4 <br />