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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# ~ 11,01 - 003 <br /> BUILDING PLANNING p <br /> Intake OK by: Date: Intake OK by:(/�V Assign To: i b. Date: 7/h✓/22Zi <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ef 6/7 ,,5IF' Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size !/f//A0 Zone l l <br /> Number of Stories / Overlay/Agreement Basement 'No ❑Yes, Fin/Unfin Nonresidential Use +tVlrati-1L <br /> Type of Construction 1/4 Residential Use <br /> Occupancy Group A Z Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers:14Update Existing ❑New System ❑NotReq'd Planning/Landscape Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: (Update Existing ❑New System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑ DivYes II .No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? oyes isiNo Additional Notes: <br /> VALUATION CALCULATION: Total$ja 5.04,4.D b <br /> Approved By: / Date: 7/1/2I.-2i <br /> c PUBLIC WORKS / <br /> Intake OK byr-r•-% Date: 'l 16.11►ZZ- <br /> Additional Notes: Intake Comments: i PW Date.:Worksheet Needed if: <br /> DSys Dev Eval DTraffic Mit Eval <br /> 1 w+:y�-3 Ire— ea...,) �' [DSite Work or Drainage Proposed <br /> I DBackflow Prevention for high hazard: <br /> Approved B : Dater ��� *a'� �-�'p►•'�,L oar `��� !(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 /> El Fire Sprinklers ❑Fire Alarm "Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: it/1/r' jc,- ❑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/Insp tion Sc��o/ppp/ee-�-ADD FIRE FEE ❑ Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:�.._//�/%17 Date:47/y/7p1L Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING —t 15-ki.,2 t <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />