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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) I PERMIT# P2i) Z t0 3"40 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <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 /> BIdgITl/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size YES Zone 2"" <br /> Number of Stories Z. Overlay/Agreement <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction (/Q Residential Use ( , ,eel Sc2 <br /> Occupancy Group iQ-J Proposed No.of Dwelling Units: <br /> Occupancy Load $ Total No.of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing ❑New System rklot Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New Systemlot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes S No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes NiNo Additional Notes: <br /> VALUATION CALCULATION: Total$/°4 OOd.OD <br /> Approved By: o Date: '23.j 74 <br /> UBLIC WORKS `�� <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> IDSys Dev Eval ❑Traffic Mit Eval <br /> i❑Site Work or Drainage Proposed <br /> Approved By; ,�,,f Date:py/2.Io/ze� �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 /> OFire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works a <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- O FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Sco e-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspectio cope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 'El Public Works has no scope---PW Not Required <br /> +ditional Notes: <br /> ELECTRICAL Ajo ID <br /> Additional Notes: ���� <br /> Approved By: Date: Approved By: Date: 4 if,10 f 202,1 <br />