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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) 4111 PERMIT# $ZZO Zf'—OO`Z <br /> BUILDING . _ , PLANNING " . <br /> Intake OK by: gl Date: Lf(2_ i2-°Z2 Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addrize ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories L -fit Overlay/Agreement <br /> Basement ONo ®Yes ,EP/Unfin Nonresidential Use . <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load TIC • • Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing El New System RNot Req'd Planning/Landscape Inspection Requi--d before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System RNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes RI No El Everett School Dis ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional N• .. : <br /> VALUATION CALCULATION: Total$ Si 9mc <br /> Approve Date: I-A,'Z <br /> PUBLIC WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: `PW Worksheet Needed if: <br /> ;DSys Dev Eval DTraffic'Mit Eval <br /> • ❑Site Work or Drainage Proposed. <br /> Approved By: `Z— Date: L//2 3T/ZeZZ '�Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT DRoute 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: ; ❑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 ❑ 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: !G -ublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: q T/t 1 J14y2/Z <br /> Approved By: Date: Approved By: Date: <br />