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Intake & Approval Sheet <br />• (FOR PERMIT STAFF ONLY) * PERMIT # 2-203 -owl 0 <br />BUILDIN <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />:EgNo ❑Yes , Fin / Unfin <br />Type of Construction <br />V — 49 <br />Occupancy Group <br />S — <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes o <br />VALUATION CALCULATION: Total $ 'Z/. 090 <br />IL-0;b 4 <br />t �J0 <br />Additional Notes: <br />Approved By: Date: 9-1 W144- d2vt <br />FIRE (DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />O Review / Inspection Scope - ADD FIRE FEE <br />Approved By: U LVVI Date: 6 <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />.:ANNING::�;, <br />Intake OK by: Assign To: Date: <br />Intake Comments: 1 <br />oc3 <br />❑ Attach to Project No,5z: A ';'-o O t <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? Imes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 92 <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: Ji-l�j�(, j�2�t�`� /0 <br />T�s ����- Tv�-��-//6Llr� ,y✓U <br />(� l <br />d LL !/lt°w tli ~[iL�/ /OG�fJJ'r Mp G`� J%I� `�4✓ti' <br />Approved By: Date: <br />PUBLIC WORKS. <br />Intake OK by: Date: <br />..... .... ....... ......... .... ........................ .......,,.......,,..,.............................,.......-..................... <br />Intake Comments: PW Worksheet Needed if., <br />❑Sys Dev Eval ❑Traffic Mit Eval <br />I ❑Site Work or Drainage Proposed <br />�OBackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />Isupportive housing) <br />t...........,.,- ..... ................ ..... ._. ......_.. ..... .... <br />❑Route this folder for PW Review at end --- PW Review Wor..,k..sheet ............_................ .. <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folder for permit issuance) <br />❑ Will be Issued separately (separate Green Folder, PW issued ahead of Bldg) <br />Public Works has no scope --- PW Not Required U't%LTT/L;5 <br />Additional1�/lN tes. / IT ?d (V�� — � Pz-L1c%�� <br />Approved By: Date: <br />