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Intake &Approval Sheet (FOR PERMIT STAFF ONL19 • PERMIT#-F; 1)K <br /> BUILDING j PLANNING <br /> Intake OK by: or0V Date: A�1 Zc2?/ Intake OK Assign To: 'NA_P. Date: 1 • <br /> Intake Comments: Intake Comm n 5: <br /> fitl Route to Commercial Building ❑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 /> Bldg/TI/Addn/Rem Size 1g ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone ) <br /> Number of Stories Overlay/Agreement <br /> Basement ixNo ❑Yes, Fin/Unfin Nonresidential Use �1.�lAo2c �1 <br /> Type of Construction V Residential Use <br /> Occupancy Group A- � Proposed No.of Dwelling Units: <br /> Occupancy Loadg ) Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing IN1New System ❑Not Req'd Planning/Landscape Inspection Required before Final? Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: s Amount$ <br /> Fire Alarm: ❑Update Existing I2INew System ❑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 123 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add''RCW 64.55 does required prior to final? ❑Yes No Additional Notes: f4,taC—� .4- Ask` 4`k-- `-k : <br /> VALUATION CALCULATION: Total$ ��ctE'O c' v ' {���. � P`w^�G N <br /> Approved B Date: , l 7- Z Z_ <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> = Sys Dev Eval DTraffic Mit Eval <br /> =OSite Work or Drainage Proposed <br /> Approved By: 45e7, Date: yezepoja LIBackflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> !supportive housing) <br /> FIRE DEPARTMENT ❑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 /> 'Eire Sprinklers kiXf ire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: IE This Permit is Approved by Public Works <br /> K. See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: KA Separate PW Permit is Required(Permit#:PW 2. '02lo <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 5a Is located in this folder <br /> 0 Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> EtReview/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:k<i ottiA Date:/ - /-a23 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B . 'G✓tf Date: o511.$/Z0Z2 <br />