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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# PIN ZO()%(,nb{P <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK bT'Assign To: Date: K C <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 /> Bldg/TI/Addn/Rem Size e- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone — I <br /> Number of Stories 2._ Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group - j Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ONew System pNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes INNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System E4Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 12 No ❑Everett School Dist — Mukilteo School Dist <br /> Addl RCW 64.55 doss required prior to final? ❑Yes e•No Additional Not . <br /> VALUATION CALCULATION: Total$ 1, �j '4 <br /> (.. c74-) f) <br /> Approved By: Date: \Q,20,ZzZG <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> `OSys Dev Eval ❑Traffic Mit Eval <br /> =OSite Work or Drainage Proposed <br /> Approved By: ( ' '� Date: a 10_,,-.4,t <br /> �Backflow 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: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm El 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 /> ❑ 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: E/Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: tO 2Ti2 <br /> z <br />