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Intake &Approval Sheet '(FOR PERMIT STAFF ONLY) II PERMIT# 22cB—025 <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 ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size la.7q ch ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone O <br /> Number of Stories J Overlay/Agreement <br /> Basement ecNo ❑Yes, Fin/Unfin Nonresidential Use iO i WV't' ' <br /> Type of Construction 1 Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: / <br /> Occupancy Load16 Total No.of Dwelling Units: <br /> Fire Sprinklers:Jpdate 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: VUpdate Existing ❑New System ❑NotReq'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑ ,�fYes 1� No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes MNo Additional Notes: 1iskribi t— Of A 03,— <br /> VALUATION CALCULATION: Total$ c9S(/� CV47 ,L'eAlt .4 0 <br /> Approved By: Date: , 5 , 'a,22_, <br /> JUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PWWorksheet Needed if: <br /> €❑Sys Dev Eval ❑Traffic Mit Eva! <br /> saOSite Work or Drainage Proposed <br /> Date: ( _❑Backflow Prevention for high hazard: <br /> Approved By: 747--- ;(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 OSubmitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> 0 See 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 ❑ 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 /> Si Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date:a //r .yvt Public Works has no scope--- PW Not Required <br /> G Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: <br /> Approved By: Date: Approved By: ! Date: /7 2 <br />