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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: N Assign To: d Date: 3-lo- Z020 <br /> Intake Comments: Intake Comment : <br /> '1�59lt lenui- (p° o �.e.(s) n..'e-_ oYt�J 10 �n�ir , <br /> n \ \ cQ.v1\P if)(CU-s.""-- 5 ''1/4-‘",Q()- u)/P2lt-')5- <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 151OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size _ Zone ,12-_2 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use C1-QA-0.G\,.Q 5 - <br /> Occupancy Group Proposed No.of Dwelling Units: -- <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Mew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yeslo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <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 chool Dist <br /> Add'I RCW 64.55 docs required prior to final? Oyes 0 No Additional Notes: `_,,, <br /> VALUATION CALCULATION: Total$ P1CW-t 0„� i�� <br /> Approved By: 1(,. k Date: 2).13-•lJr o <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> 3❑Sys Dev Eval ❑Traffic Mit Eval <br /> =DSite Work or Drainage Proposed <br /> Approved By: Date: ❑Backflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> _supportive housing) <br /> FIRE DEPARTMENT DRoute 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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: I^I. his Permit is Approved by Public Works <br /> 0 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 /> 0 Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 Review/Inspection Scope-ADD FIRE FEE 0 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: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By ' <br /> Byri Date: S J3/2.41-z4.1 <br />