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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) * PERMIT# 2203
<br /> BUILDING PLANNING
<br /> Intake OK by: Date: Intake OK by: Assign To: Date:
<br /> Intake Comments: Intake Comments:
<br /> 0.� \\--e-j\GA \kb CI\SSC.- C 9_
<br /> ❑ 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 e 6l'll ❑ Hold in Planning File Drawer
<br /> Garage/Accessory Struct. Size Zone
<br /> Number of Stories 9 Overlay/Agreement
<br /> Basement ElNo Yes , Fin/Unfin Nonresidential Use
<br /> Type of Construction V� Residential Use AT.
<br /> .V
<br /> `?.
<br /> Occupancy Group Z. Proposed No. of Dwelling Units: LVO`KCili (
<br /> Occupancy Load Y\ hti � Total No. of Dwelling Units:
<br /> Fire Sprinklers: El Update Existing ❑New System L:JNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes DNo
<br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$_-- -
<br /> Fire Alarm: ❑New System
<br /> DUpdate ExistingEl Not Req'd School Impact Fee: Total $
<br /> Reason Fire Alarm Required: ��--5y Calculated: redit:
<br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes L-I No DEverett School Dist Mukilteo School Dist
<br /> ❑ ty:
<br /> Add'I RCW 64.55 docs required prior to final? Yes .INo Additional Notes: /'
<br /> VALUATION CALCULATION: Total $ . */
<br /> Approved Date:
<br /> PUBLIC WORKS
<br /> Intake OK by: Date:
<br /> Additional Notes: Intake Comments: NeededPW Worksheet ,,,,,,,,,,,,,,,...,...,,,,,.,,,,.,.,,,.,....,,,,..,,.
<br /> if:
<br /> ❑Sys Dev Eval ❑Traffic Mit Eval
<br /> ❑Site Work or Drainage Proposed
<br /> Approved By:'�, Date: LI I I 2-2 ❑Backflow 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 /> DFire Sprinklers El Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ODeferred
<br /> Additional Notes: ❑ This Permit is Approved by Public Works
<br /> ❑ 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 /> ❑ Review/ Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW,issued ahead of Bldg)
<br /> Approved Byft,,_QA. fi , "I I- 4 I 22, o Public Works has no scope--- PW Not Required
<br /> Additional Notes:
<br /> ELECTRICAL
<br /> Additional Notes:
<br /> Approved By: Date: Approved By: Date:
<br />
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