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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT 2200 0 - <br /> ifr...it <br /> v__ BUILDING PLANNING <br /> Intake OK b Date: Intake OK by: t/"'f) Assign To: A )4„g . Date: (i/I/ZFIL2. <br /> Intake Commen s. Intake Comments: <br /> Route to Commercial Building " " ma) El Attach to Project No. <br /> Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone WI 1 U <br /> Number of Stories Overlay/Agreement 5},O(/\,Ca4.-19' <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group 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 before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update 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 ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ -Ortiiti ll!l..��' n <br /> ' v" 8✓.—(21 <br /> i� I/n 1 LP i;,UJ/72 <br /> Approved��B..yyy Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> t❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: �d� Date: 60+1 ZorL� ❑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 /> DFire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder OSubmitted 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 /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: =-'ublic Works has no scope--- PW Not Required <br /> Additional Notes:- £� 1,..swA.K:)1,1Z> A5_�um-Ts <br /> ELECTRICAL/PLUMBING ,µo,,.►uMG..+-r si co.) t s ou-rslav_ 17-e.4.4 <br /> Additional Notes: to / 4-I?02t_ <br /> Approved By: Date: Approved By: Date: <br />