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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# ?(2-(2) -O C C� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by( Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to 6.mmercial Building ❑ Attach to Project No. <br /> ❑ Route to Re 'dential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a " Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Si ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. ize Zone <br /> Number of Stories Overlay/Agreement <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use y��ti� — —%/1 -� <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ONew Syst-' ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ■ of Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? NYes ❑ o ❑Everett School Dist Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ (61)0 k <br /> Approved B Date: � �� 2a <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> `\Ck\C ❑Sys Dev Eval Traffic Mit Eval <br /> El Site Work or Drainage Proposed <br /> Approved By: We e,,tND Date: )-/•8/;71.- ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT El 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 /> OFire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> 0 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 /> M Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: OF Cnl`f1D Date:2i1;12\ El Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: A'‘A Date: 'A1;.Iq 2.0 <br />