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Intake &Approval Sheet . (FOR PERMIT STAFF ONL19 0 PERMIT# lb 220g -of C9 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK Assign To: Date ligZ <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> Make this a"W"Permit 0 OK to Route to Other Departments <br /> /TI/Addn/Rem Size //Z � 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size )4 Zone T.) <br /> Number of Stories t Overlay/Agreement <br /> Basement EINo ❑Yes, Fin/Unfin Nonresidential Use c f l t/1 -f'*fri) ce'oe <br /> Type of Construction V/6 Residential Use _ • <br /> Occupancy Group B Proposed No.of Dwelling Units: <br /> Occupancy Load '2— Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Chew System piNot 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'1Not 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 Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes a No Additional Notes: <br /> VALUATION CALCULATION: Total$ 800 00 <br /> lat _ ,Pit 1fxi'i'uQ1 Stiqin <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: 'P' Date: e i6 FL'Z2 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: - - <br /> S -Pv-r2Zc4 'o15 <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> El Site Work or Drainage Proposed <br /> 4 r\1,,, Date: OJ L/z ort ❑Backflow Prevention for high hazard: <br /> Approved B <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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire D t.Fees: ❑A Separate PW Permit is Required (Permit#: PW ) <br /> ti—Revfew 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 /> eview/Inspection Scope-ADD FIRE FEE 0 Will be issued separately (Separate Green Folder,PW Issued ahead of Bldg) <br /> Approved By:V.,.'QT, ( T \ Date:Ck—G'',2_,), 17715ublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING -� e[2,11.01.1. <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> ' al, <br />