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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT # IJZ?i U - 0(0(0 <br />BUILDING <br />Intake OK by: Date: ld�3I2�?/L <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />yy LA 5 F <br />Garage/Accessory Struct. Size <br />S 3'7 SF <br />Number of Stories <br />3 <br />Basement <br />ENo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />rrDp�� <br />Fire Sprinklers: ❑UpdateExisting-lNewSystem ❑ Not Req'd <br />Reason Sprinklers Required: gl("p"fr rLV.2 <br />Fire Alarm: ❑Update Existing El New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 20 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ®No <br />VALUATION CALCULATION: Total $ Zl;�; I0-7 <br />Additional Notes: <br />Approved By: - Date: f 0/ S/2,022 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑`Review / Inspection Scope - ADD FIRE FEE <br />Approved By: , Date: <br />ELECTRICAL/PLUMBING <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 'gyp/ v <br />Calculated: 30/0 Credit: <br />09verett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />V�ss <br />vd < h t <br />Approved By:9-0-3 1 <br />PUBLIC WORKS <br />Intake OK by: Date:�-1 - Z Z - 2g 1-ZL <br />...................................................................................................................................__..._ ... <br />Intake Comments: PW Worksheet Needed if.• <br />❑Sys Dev Eval Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />j (dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />....................................................................................................................................................Y............. <br />❑ Route this folder for PW Review at end --- PW Review Worksheet <br />This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder JAWubmitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />'See PW Review Worksheet and associated attached items <br />A Separate PW Permit is Required (Permit #: PW <br />AND ❑ Is located in this folder <br />® Is in a Separate Green Folder Gain with this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />[Approved By: Date: <br />1 f� <br />I MZZJ <br />