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Intake &Approval Sheet FOR PERMIT STAFF ONLY) I. PERMIT# 2�g 'OD co <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK bc—Dinfk. Assign To: Date:f 5/27i <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 ❑ OK to Route to Other Departments <br /> B g/TUA do/Rem Size ❑ Hold in Planning File Drawer <br /> Gar ccessory Struct.Size Zone Mt..) <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑'/Yes, Fin/Unfin Nonresidential Use 1�,, <br /> Type of Construction is74 Residential Use (YI, P l�y/L{ It. <br /> Occupancy Group AZ' Proposed No.of Dwelling Units: <br /> Occupancy Load AM Total No.of Dwelling Units: <br /> Fire Sprinklers: pUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Azipdate Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes IS1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes , No Additional Notes: � 1`' // <br /> VALUATION CALCULATION: Total$ ZS 00° ao <br /> proved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by Date: <br /> Additional Notes: Intake Comme . !PWWorksheetNeededif:• <br /> ' Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved ByIIIVJJJ��`1�2 Date:0l/�3/V'3 loBackflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary,hospital, <br /> 'supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end --- PWReviewWorksheet <br /> Separate/Deferred Submittals Required: DThis project also has a separate concurrent PW Review (Green Folder) <br /> ViFire Sprinklers Wire 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder (join with this folder for permit issuance) <br /> El—Review/Inspection Scope-ADD'FIRE FEE ;' ❑Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: \ ,c1) Cr-3(A)(\Date: g—I6-Z gf Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING ,,���,1�� �� `_ D � ���w.Aw� J���` <br /> Additional Notes: { 1-4j- eve C AI <br /> Approved By: Date: Approved By:JIM/A A 1. „/1.04_ Date: q`731 1,62.2,, <br />