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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# �22�3-b Jb <br /> BUILDING PLANNING <br /> • <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 it is ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement "MNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction \iS Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load t a Total No.of Dwelling Units: <br /> Fire Sprinklers: ®Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before F'.- : ■Yes ❑No <br /> Reason Sprinklers�Required: "In Lieu"Fee:Type: ount$ <br /> Fire Alarm: iNUpdate Existing El 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? ❑Yes r4 No ❑Everett School Dist ❑Mukilteo School Dist <br /> tcu Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes. <br /> VALUATION CALCULATION: Total$ \2zo0 <br /> Approved B Date: fS. ZOZ'L. <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> =OSys Dev Eva! ❑Traffic Mit Eval <br /> =OSite Work or Drainage Proposed <br /> (� t i ❑Backflow Prevention for high hazard: <br /> Approved By: Date: /�'(J 2,0 . <br /> (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 ❑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(loin with this folder for permit issuance) <br /> ) Review/Inspection Scope-ADD FIRE FEE ,,er�gg ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K,l nw ,\ Date:3..?22 IikPublic Works has no scope PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: �2azt- <br /> Approved By: Date: Approved By: Date: <br />