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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#Q22c .CO <br /> BUILDING PLANNING Intake OK by: Date: Intake OK b Assign To: Date: U / 0(.1.-- <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No._ ' <br /> ❑ Route to Residential Building 0 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 1 1 1 U — 3Qf OY ItC) <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 ['Not Req'd Planning/Landscape Inspection Required before Final? ['Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update 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? [hies ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ['Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total$ (00,0 O <br /> /7/0 ilk,U).- 4 koi6WS 7- I /2-i- <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by:`174.1 Date: ell 1 I 202.2 <br /> Additional Notes: Intake W r IPW Worksheet Needed if: <br /> '� t0.fA.-r I <br /> F� S LAfr(ro4..-ca. r" ❑Sys Dev Eval Traffic Mit Eval <br /> �� Zow, iDSite Work or Drainage Proposed <br /> Approved By: "' Date:pilJy7 —n.as�. �E-E t ScAFfeW�`n�a (0BackflowPreventionforhighhazard: <br /> v ��5 I(dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT 0 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 ❑Fire Alarm ['Other: AND ['Create Green Folder ['Submitted Previously ❑Deferred <br /> Additional Notes: ./o je-el ❑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 0 Is in a Separate Green Folder (join with this folder for permit issuance) <br /> 0 Review/Ins ction Scope-ADD FIRE FEE ❑Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved B , d2f, Date: p. 0.t roZZ 0 Public Works has no scope--- PW Not Required <br /> / Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />