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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# 462t Di") <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 /> ❑ Mak- this a"W"Permit ❑ OK to Route to Other Departments <br /> Bld ddn/Rem Size VS.ad/,s ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size teS Zone L.Z <br /> Number of Stories f Overlay/Agreement <br /> Basement 1 Jo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group 4 J i 5'Z" Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers:,Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yeslo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: AZIUpdate 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? oyes ,I No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: k ( ,),�, ,,� G Niaka. <br /> VALUATION CALCULATION: Total 1 t Q 1Z. )rn 1 I c lq` 3 <br /> .A\m„ <br /> Approved By: Date: 46' Zi1 <br /> P IC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed& <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By; Date:0/3/ r7 ❑Backflow Prevention for high hazard: <br /> (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 /> 1a Rre 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: g A Separate PW Permit is Required (Permit#: PW 2Jo1 — 0 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 15iIs 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:Kiaoz364.in Date:,--7—...0( ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: - Date: Of25121 <br />