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0 •Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT IrS2 2-0 2 ^ a 2 4 <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 /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2.1 4+ ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone <br /> Number of Stories ,9.. Overlay/Agreement <br /> Basement IENo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction V. ^ $ Residential Use <br /> Occupancy Group M Proposed No.of Dwelling Units: <br /> Occupancy Load 52... Total No.of Dwelling Units: <br /> Fire Sprinklers: CUpdate Existing ❑New System lgiNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System El Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: L ' FIC('bilkifk Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? Yes IN No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes INo Additional Notes: <br /> VALUATION CALCULATION: Total$ 1:_4 i bob <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: i PW Worksheet Needed if: <br /> 'OSys Dev Eval ❑Traffic Mit Eval <br /> OSite Work or Drainage Proposed <br /> Approved By: ' Date:.d.12,y,f y�ti�Y OBackflow Prevention for high hazard: <br /> -�_ !J _(dental,medical,animals,mortuary,hospital, <br /> /am V ( g ('2-c V.._ _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 /> 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 ❑ Is located in this folder <br /> Minimal or No Fire Scope-NO FIRE FEEpl:, <br /> El Is in a Separate Green Folder(join with this folder for permit issuance) <br /> eview/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved Byc ALf2c) Date: "2 f�2.Z ;Fl 'ublic Works has no scope---PW Not Required <br /> `� Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: 2 in /24 22 <br /> Approved By: Date: Approved By: Date: <br />