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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) II <br /> PERMIT# ,L 610,0 !✓ <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: 1V 1 Date: 10'1.20 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 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 /> Bldg/TI/Addn/Rem Size j (Q iq-5 -1 0 Hold in Planning File Drawer <br /> 1 l� <br /> Garage/Accessory Struct.Size Zone o-1 <br /> Number of Stories 2 Overlay/Agreement <br /> Basement 03No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Y_ Residential Use <br /> Occupancy Group `� Proposed No.of Dwelling Units: <br /> Occupancy Load i(122- Total No.of Dwelling Units: <br /> Fire Sprinklers: ®Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: 121Update 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 does required prior to final? ❑Yes EEINo Additional Notes: <br /> VALUATION CALCULATION: Total$ 174:::/:;71 0L90 <br /> Approved By: VQç03 4 e' 0 \ 2020 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> IDSys Dev Eval ❑Traffic Mit Eval <br /> i DSite Work or Drainage Proposed <br /> Approved By: Date: 12'ty2t t7 <br /> {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/Deferred Submittals Required: OThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND OCreate Green Folder OSubmitted Previously ❑Deferred <br /> Additional Notes: • 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 0 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: .e>mr'J) Date:/dp,V Q a Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: A.v Date: 0/Is- 9.. _�� <br />