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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) I PERMIT# liY7,CO\ 0711. <br /> BUILDING y� PLANNING <br /> Intake OK by: 4-- Date: j //av Intake OK by: Assign To: Date: <br /> Intake Comments: GGG 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 /> Bldg/TI/Addn/Rem Size %1 l4/A ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement o ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction r`lek Residential Use <br /> Occupancy Group /3 Proposed No.of Dwelling Units: <br /> Occupancy Load — -- 47, Total No.of Dwelling Units: <br /> Fire Sprinklers: CI Update Existing ❑New SystemNot 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 ❑New System IiiNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Vino DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 dots required prior to final? ❑Yess 1No Additional Notes: <br /> VALUATION CALCULATION: Total$ 0.170C, <br /> Approved By: —7 2 Date: // A0 <br /> PUBLIC WORKS LL <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> AL =DSys Dev Eval DTraffic Mit Eval <br /> rU 7 /020 <br /> joSite Work or Drainage Proposed <br /> Approved By: 2? Date: 1 / ? =�Backflow Prevention for high hazard: <br /> `< _(dental,medical,animals,mortuary,hospital, <br /> Isupportive housing) <br /> FIRE DEPARTMENT ❑Route 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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted 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 ❑ Is located in this folder <br /> .11 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: / /j //V VPublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: ll / <br /> Approved By: Date: Approved By: Date: t/ p /7Q <br />