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• rIntake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#SZCO" ^' 02-9 <br /> BUILDING PLANNING, <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2.S SF.- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone e-r <br /> Number of Stories I Overlay/Agreement <br /> Basement /2 Yes , Fi Unfin Nonresidential Use <br /> Type of Construction ''W$ Residential Use &Ct- ( �- <br /> Occupancy Group /tA Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ,Jo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System El 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 rigi„No ❑Everett School Dist ❑Mukilteo Schoo Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 2No Additional Notes: <br /> VALUATION CALCULATION: Total$ I 3O4Oi''c <br /> 42Z41e. 73/St' <br /> Approved By: K. Date: <br /> 2Sto e / r = /27 aeo <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: ��`$ //,�[^ Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: ‘`Z112.0 ❑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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 /> O 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: laPublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: �� Date: : jj <br /> pp pp j� �4 , <br />