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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#,2.O1b`"Co S <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK b Assign To: wC Q Date: M.Co. -01.0 <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 d(o 'q--i c {' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size - Zone LI -� <br /> Number of Stories ± Overlay/Agreement <br /> Basement InNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction -jt - [7 Residential Use <br /> Occupancy Group $-2_ Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing %',New System ❑Not Req'd Planning/Landscape Inspection Required ore Final? ❑Yes 111No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing lEINew 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 ® No ❑Everett School Dis ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? oyes ®No Additional Notes' <br /> VALUATION CALCULATION: Total ! 1 <br /> q-to % 18 `e- 2.05x1.0o.C;) = <br /> Approved BC-may Date: 1 C` trsto <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: 1� Date: ❑Backflow Prevention for high hazard: <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 /> lif-Fire Sprinklers El 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 /> Er-Review/ Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K,9 x,0,c\ Date:10-1 -a0 12(Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL SE 1c ?VI '-0011j-0 VI, <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: ) V. 1 ? <br /> 2,-/7 <br />