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0 0 2111- 02- 1 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <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 ❑ oute to Historic Reviewer <br /> ❑ Mathis a"W"Permit OK to Route to Other Departments <br /> Bldtat dn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone KK.-3_— <br /> Number of Stories Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use A4j <br /> Occupancy Group l22-- Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El 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: El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: t�pp Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? y�Yes ❑ No El Everett School Dist ❑Mukllteo School Dist <br /> Add!RCW 64.55 does required prior to final? DYes EINo Additional Notes: <br /> VALUATION CALCULATION: Total$ S-d b0r 6 0 <br /> Approved y: Date: 11 . 1 Z,. 24 <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> i❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: F,„%F Date: /�%>�� Z., ❑Backflow Prevention for high hazard: <br /> £(dental,medical,animals,mortuary,hospital, <br /> `supportive housing) <br /> • <br /> FIRE DEPARTMENT El Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> . <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 /> aminimal 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:Y....v2)-co(,k,94-\ Date: \\—V --21 LS0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: U Date: `( !O6 <br /> 2 --- <br />