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P I <br /> 'Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 22or`(• 01 <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: *. Date: /-312032 Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Lzi Route to Commercial Building ❑Attach to Project No. <br /> ❑Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2.481 44-'' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone <br /> Number of Stories t Overlay/Agreement <br /> Basement ONo DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction -t• Residential Use <br /> Occupancy Group te. Proposed No.of Dwelling Units: <br /> Occupancy Load 1 0, Total No.of Dwelling Units: <br /> Fire Sprinklers: 121Update Existing❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Reason Sprinkle�ss,Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: L'�Update Existing❑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? DYes I No DEverett School Dist ❑Mukilteo School Dist <br /> Add'RCW 64.55 dots required prior to final? DYes ONo Additional Notes: <br /> VALUATION CALCULATION: Total$ 'c00, 4100 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PWWorksheet Needed if:- <br /> =DSys Dev Eval DTraffic Mit Eval <br /> I <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: 75/ej 20 DBackflow 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 /> -Sprinklers Mire Alarm ❑Other: AND OCreate Green Folder ❑Submitted 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 Of-Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: CL�.„_.1 n Date: 5/ ^�� ElPublic Works has no scope---PW Not Required <br /> C'OrA.AN 1 ,2 2 Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />