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A i <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#D 2i -c-og 0 <br /> BUILDING PLANNING , <br /> Intake OK by: Date: Intake OK by: L ' Assign To:114.04 . Date:5/3' <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 /> BI g Rl ddn/Rem Size �xc l Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ,,t./�,dj Zone 1--S Z <br /> Number of Stories / Overlay/Agreement <br /> Basement .a'Jo ❑"Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction .�—/.5 Residential Use <br /> Occupancy Group ,Q F S I Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers:,oiUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <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 , No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$f-Yi, Oedt", G'‘::" <br /> Approved By: ./'�� �,k_._ T—5'S ,.,_ ,2_,1 <br /> PUBLIC WORKS qt .: `.'', <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: -PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> / ❑Site Work or Drainage Proposed <br /> Approved By: „......✓ Dated / yo1� '❑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 ❑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 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: c,../7� Date:,j t % El Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL _ ' <br /> Additional Notes: <br /> In lb <br /> Approved By: Date: Approve. N Date: <br />