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LA <br /> Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT£2O2 -O( <br /> BUILDING PLANNING <br /> Intake OK by: `ter/, Date: 2/I j Lo _t Intake OK by: Assign To: Date: <br /> Intake Com !m: 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 2,4- -7-- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size _ Zone <br /> Number of Stories A— Overlay/Agreement <br /> Basement ❑No wYes , Fin/Unfin Nonresidential Use <br /> Type of Construction y-cl-v T-- Residential Use <br /> Occupancy Group 1FZ-2- Proposed No.of Dwelling U► s: <br /> Occupancy Load Total No.of Dwelling Uni -: <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape spection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd School Impact Fo-: Total $ <br /> Reason Fire Alarm Required: rsn Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1 No ❑Everett hool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes iA No Additional Notes: <br /> VALUATION CALCULATION: Total$ gpi'"r" <br /> Approved By Date: 2_\\,2dd <br /> PUBLIC WORKS <br /> Intake OK by: i t1 Date: 2.11 fro 2-a <br /> Additional Notes: �Ta t Intake Comments: PW Worksheet Needed if: <br /> EA-A. t-tiJt'rs if,a-CE � ;02 O ' I❑" ` `P Sys Dev Eval ❑TrafficMitEval <br /> I❑Site Work or Drainage Proposed <br /> Approved By: Date: 2.1 I 4,4 O �,`� Sc ?p i❑Backflow Prevention for high hazard: <br /> fl (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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> T Fai' 1 —P,zitt-"j(At� 'w v.� t-1. t,. V14I-ram✓ ElSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> -. . 0 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ✓ Date: Z/( a.e .b P 2u_blic Works has no scope---PW Not Required <br /> Fri TrtR.0 Additional Notes-.... ----- 6 2— [ <br /> / her-La <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />