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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT#�2.203 —0G,3 <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 as�"W" Permit _ El OK to Route to Other Departments <br /> Bldg/TI/Add Rem Siz,e) 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ^%t Zone '-; <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use =i -044( <br /> Occupancy Group /Z—C Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: El Update Existing El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes glNo <br /> Reason Sprinklers Required: li "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ` INot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? �1:1Yes :No El Everett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ]Yes No Additional Notes: y'P IV }-i; CACI S Mc ( L KV'51,4,y„ <br /> Cilj') <br /> VALUATION CALCULATION: Total $ Zu <br /> trf 0�'G•L'C ti `a - &S) <br /> � n� �-1r.�'Gtrl G4 -- y,et.:�C,� Ci C � �Tl'�.. {'I,� __ <br /> Approved By: IL. ) Date: y-(.,"1 L <br /> J PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet <br /> Needed Neededf i .....,, <br /> f: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> El Site Work or Drainage Proposed <br /> .. , /0®�? ❑Backflow Prevention for high hazard: <br /> Approved By: Date C'� ` :(dental,medical,animals,mortuary,hospital, <br /> 'supportive 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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 /> ❑ 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: `' ¢/rc tiV22 <br /> Approved By: Date: Approved By: Date: <br />