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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#`�—' 2 (..°Z -o( 0 <br /> BUILDING PLANNING <br /> Intake OK b i J ZD /s Q, <br /> �Zj Date: j/ ,,�� � Intake OK Assign To: MO Date: �. <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 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 /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size/ Zone - <br /> Number of Stories 1 Overlay/Agreement s t \ t1� c 'QSC.\ <br /> Basement 7:\1_1o2kY , Fin/Unfin ' U( \\���Type of ConstructionResidential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 6 Total No. of Dwelling Units: �W CO <br /> Fire Sprinklers: El Update Existing ❑New System NNot Req'd Planning/Landscape Inspection Required before Final? ❑ ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: A <br /> Fire Alarm: ❑Update Existing ONew 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? DYes 2No ❑Everett School�ts`t ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> 5c,,-)�� -) 7 5- <br /> - k.y. ec <br /> Approve Date: <br /> Y"C S Le. PUBLIC WORKS <br /> WrU 5F .r <br /> Ipeake OK by: Date: <br /> Addit "Intake Comments: iPW Worksheet Needed if: <br /> •(, '❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Appr f\ - f , ❑Backflow Prevention for high hazard: <br /> C42,CZZ.. :(dental,medical,animals,mortuary,hospital, <br /> (supportive housing) <br /> ,__ 0 Route this folder for PW Review at end ---PW Review Worksheet <br /> Sepa -10C ❑This project also has a separate concurrent PW Review(Green Folder) <br /> OF AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> r Addit (A G c-- 13-This Permit is Approved by Public Works <br /> 7?/�Vfl, E{-See PW Review Worksheet and associated attached items <br /> Fire I t Separate PW Permit is Required (Permit#: PW 22.Q5--O°S ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND lErts"located in this folder <br /> O 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By`_* r__(_ - Date: ,...51 I f io21- <br /> v <br />