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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT#b 220g-mu( <br /> �/ BUILDING PLANNING <br /> Intake OK by: �/{.i' Date:q 11 J r 71 27/ Intake OK bl.-00/L Assign To: Date: 43I6// <br /> Intake Commeennt�: Intake Comments: <br /> ,,(❑ Route to Commercial Building 0 Attach to Project No. 17\-(7+-f‘Cy'](fit �(� a <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer l <br /> 0 Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone '\---- <br /> Number of Stories % Overlay/Agreement <br /> Basement ❑No EYes,10 Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group . )IL- Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ISINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System QNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Et No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes R1No Additional Notes: <br /> VALUATION CALCULATION: Total$ 5o <br /> r. rn <br /> qc:ft <br /> Afeucbmio,,.. Ilytila Or <br /> . /f6/ & <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> W1-1 Ism Intake OK by: Date: <br /> Additional Notes: ktlIP) p ®"N L Intake Comments: IPW Worksheet Needed if: <br /> u,P,Al ova <br /> ❑Sys Dev Eval ❑Traffic MitEval <br /> i❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: ,,-4, Date: el//57 Z, (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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: aThis Permit is Approved by Public Works <br /> 0 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 0 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 0 Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Iic s no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: <br /> Approved By: Date: Approved By: ' /�,I,I4 � v� � Date: eg 11�I Zp?jL <br /> NLI/I��tf/v vI <br />