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• <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# fF 2-262^OZc <br /> BUILDING PLANNING' • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use . <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ['Update Existing ❑New System tNot 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 1Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Ii No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes CiiNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 3a cr70 <br /> Approved By: iL. Date: `2,4 0 ,7�Z <br /> • BLIC WORKS.' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> • <br /> • El Site Work or Drainage Proposed• <br /> Approved By: ��yr9 <br /> > Date: - J It'�p�2 3OBackflow Prevention for high hazard: <br /> ;)via-` ` (dental,medical,animals,mortuary,hospital, <br /> !supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate 1 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 ODeferred <br /> Additional Notes: , <br /> ► This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By"�p Date: . /(( fe_oz_ <br /> �lZ <br />