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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 4 53 <br /> BUILDING PLANNING <br /> an I <br /> Intake OK by: Date: Intake OK byJP Assign To: Date: Z/17/ZZ <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/Ad. 4.ciap ❑ Hold in Planning File Drawer <br /> ...� �2 <br /> Garage/Accessory truct.Size kFiS Zone <br /> Number of Stories l Overlay/Agreement <br /> Basement NINo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction 212C Residential Use ST-' , <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 3 Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System 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 A No El Everett School Dist ❑Mukilteo School Dist <br /> Add'i RCW 64.55 docs required prior to final? oyes piNo Additional Notes: <br /> VALUATION CALCULATION: Total$1 Do°,-049 <br /> Approved B A&.0 in(16(r,0 Date: 'Z.,/N.p 12 , <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: ow RF07/4, VoT Intake Comments: I PW Worksheet Needed if: <br /> �✓� G1/Suii'trrrdL t' S IDSys Dev Eval ❑Traffic Mit Eval <br /> )OSite Work or Drainage Proposed <br /> Approved Date:c', b®2421_, 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/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: piThis 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: i( `� e Date: O(J/ /2ozi <br />