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22 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 033 <br /> BUILDING // PLANNING <br /> Intake OK by: / Date: / o'11, Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> oute 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 ZSS 5f 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories 2 Overlay/Agreement <br /> Basement ❑No InYes(Fil Unfin Nonresidential Use <br /> Type of Construction ,sit <br /> '- Residential Use d _ <br /> Occupancy Group IV" Proposed No.of Dwelling Units: ^ F� <br /> Occupancy Load Total No.of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing ❑New System , Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes iNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ / <br /> Fire Alarm: El Update Existing El New System iErNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes In No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: J Q (21/4.Y2A. �f t ' to / <br /> VALUATION CALCULATION: Total$ - L) X) -ik;ti4j r I, <br /> Approved By: {/ Date: (, qt. Z Z <br /> BLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: FA.5wievr cone �/ Intake Comments: PW Worksheet Needed if: <br /> s❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: �j�Date: ©J/ vv ❑Backflow Prevention for high hazard: <br /> I :(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 /> ❑Fire Sprinklers ❑Fire 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 issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: rail Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: •'�7/r �~ z.I- <br /> Approved By: Date: Approved By: Date: <br />