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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �2\OA'0 J J <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories r 1 Overlay/Agreement <br /> Basement lo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load 24-C Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing El New System 0.Not Req'd Planning/Landscape Inspe• ion Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee: Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System Not Req'd School Impact Fee: otal $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Er No El Everett Scho• Dist 0 Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional No s: <br /> VALUATION CALCULATION: Total$ 2-0,0O0 <br /> Approved By( Date: �, V . ZCJ2� <br /> PUBLIC WORKS <br /> Intake OK by: Date: D5101)12o7) <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> IISite Work or Drainage Proposed • <br /> Approved By: giA5( Date: 1-IIZyI7.0-z.S ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT <br /> Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: El This project also has a separate concurrent PW Review(Green Folder) <br /> DI Fire Sprinklers El Fire Alarm ❑Other: <br /> AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: <br /> 171 This Permit is Approved by Public Works <br /> IN See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: <br /> 0 A Separate PW Permit is Required (Permit#: PW <br /> ❑ Review of As-Built Plans-NO FIRE FEE <br /> AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE <br /> ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE <br /> ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: <br /> ❑ Public Works has no scope--- PW Not Required <br /> ELECTRICAL Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By:J./Witt J11XYMO Date: O ci I r4,I?Ai, <br />