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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 13220(o - 63 <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 0 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 ❑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 CI 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: ❑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? ❑Yes ❑ No CI Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: ` <br /> VALUATION CALCULATION: Total 7,50 0 CJc.V,!.,a I" /‘ <br /> ttl- <br /> Approved By: ' Date: 6��ij'Z_ <br /> BLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> ❑Sys Dev Eval DTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By" �,,,7 Date• /// 79 ❑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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑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 FEEgm <br /> AND El Is located in this folder <br /> inimal 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: Kf Hce9t w)/1 Date: G `/C�'✓_z 2 gPublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING I" z ca.-ea— 0.1 0 S c e4fr:- <br /> Additional Notes: �— G./ r 4 12o2'Z <br /> Approved By: Date: Approved By: Date: <br />