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• • �r� <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2r of ''�.-C3 <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 ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ 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 lallo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction it - t3 Residential Use <br /> Occupancy Group S ` L Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System tgNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: 133Update Existing ❑New 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 ® No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $��i R-e! ' �/f) U �`'y��C Ar�j(�C� � —� <br /> (V <br /> Approved By: 1 Date: _53) <br /> PUBLIC WORKS ------- <br /> Intake OK by: Date: <br /> Additional Notes: • �c��, R�rw ram` Intake Comments: PW worksheet Needed if: <br /> MIS P �> te seFAAA'` E k)-‘5)—t'C:F-e^-`- ❑Sys Dev Eval OTraffic Mit Eval <br /> r ❑Site Work or Drainage Proposed <br /> Approved By: Date: •±'i 'i j ❑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 /> ❑Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred <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 By: K,l3cow y Date:_261,2/ ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: 1 , �ELECTRICAL , E .� <br /> e, \� SC , l ! rr(O t -00:i-- <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />