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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# (321 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:Cie Assign To:416 Date:ZS-202'( <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ R to to Historic Reviewer <br /> ❑ = e this a"W"Permit OK to Route to Other Departments <br /> BI• I/ ddn/Rem Size ` ySo �` Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone ��Z <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use e4tAi—C ln''1 Ca( 0 <br /> Q Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers:g Update Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: A9Update Existing El New System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes fa No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 does required prior to final? ❑Yes -No Additional Notes: 0.(( filc,aoi'(.t1r irK.. NO atanie, I Vt v c.c- <br /> VALUATION CALCULATION: Total$ ar.Od <br /> Approved By:�%J�I'1 Date: y p•2.02/ <br /> G ``ff�� PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if <br /> =OSys Dev Eval ❑Traffic Mit Eval <br /> • <br /> I El Site Work or Drainage Proposed <br /> Approved B�� Datea,.cP/�ieer/ OBackflow 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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 /> E.Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K,b c-p(fin Date: g-7: / 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: flit' nh Sop <br /> N <br /> Approved By: Date: Approved By: Date: <br /> �7i <br />