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• 22o2-lc I 0 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: _ Date: Intake OK b Assign To: Date:Z/10 lL7 <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 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 Overlay/Agreement <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use ielti rj wire,le -dad s I <br /> Type of Construction Residential Use JJ <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing El 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: El Update Existing El New System El 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 El Everett School Dist ❑Mukilteo School Dist <br /> Add'RCW 64.55 docs required prior to final? ❑Yes ONo Additional Notes: <br /> VALUATION CALCULATION: Total$ Sd�v <br /> Approved�Xf<4. 1 I tk°aDate: ZIl[ G_ <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: R�vI ��¢ --•y•s�re Intake Comments: PW Worksheet Needed if: - -- - - � <br /> €DSys Dev Eval OTraffic Mit Eval <br /> OSite Work or Drainage Proposed <br /> Approved By: 7 Date: "�/9/,z,b?� l�Backflow Prevention for high hazard: <br /> f( ;(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT El 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 /> El Fire Sprinklers El 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 FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: CI Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: _A`,J/y �!,oyp ye. O .5//5120 LZ <br /> Approved By: Date: Approved By: ((// !! Date: <br />