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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY)4111 PERMIT# (AO \2j i <br /> BUILDING PLANNING <br /> Intake OK by: t Date: 1z/tia c Intake OK by: Assign To:MS i)( Date: '2-110 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> IR Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"PermitK to Route to Other Departments <br /> Bldg/TI/Add 400 ize 2-32, Sf2 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size . Zone 2— <br /> Number of Stories ( Overlay/Agreement <br /> Basement ❑No IYes,(riD Unfin Nonresidential Use <br /> Type of Construction Residential Use Sf� <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: CI Update Existing El New System ®Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes,No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System SNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: � Calculated: Credit: <br /> ❑ IN <br /> RCW 64.55 MF worksheet req'd for permit? Yes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes 0 No Additional Notes: <br /> VALUATION CALCULATION: Total$ Z4:7102.Z <br /> Approved By:(AV Y Date: + 11.1:1/2,0 <br /> PUBLIC WORKS <br /> Intake OK by: —CIA Date: !Zito I Zoe I41 <br /> Additional Notes: /4.0 GUSi6C Intake Comments: IPWWorksheetNeededif: <br /> l""tt ¢ �t - G R"'. t DSys Dev Eval OTraffic Mit Eval <br /> O"�'�'� _['Site Work or Drainage Proposed <br /> Approved By: , Date: //2 S 2p "''0 V\M Scoe I DBackflow 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 I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ID Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: El This Permit is Approved by Public Works <br /> ❑ 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ 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: Date: 4Pcblic Works has no sco PW Not R quired <br /> Additional Notes: fZ 1 to ILbE,. <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />