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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 9'-2-O \2�bLk'D <br /> BUILDING PLANNING <br /> Intake OK by: ��1"�n Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> C A.N&c QQ )n.SA'S/. 213 <br /> ❑ Route to Commercial Building WI Attach to Project No. ),\C()\q_ <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 Ck` 2. <br /> Number of Stories / f pert(rt( Sf /UA. Overlay/Agreement `(���� S� C�C <br /> Basement J No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction C Residential Use S� <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load . --- Total No. of Dwelling Units: c \Q C�> <br /> Fire Sprinklers: DUpdate 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-426ot 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!RCW 64.55 docs required prior to final? ❑Yes Q,No Additional Notes: <br /> VALUATION CALCULATION: Total$ I ti 1 Z <br /> Approved B Date: `C OA <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Site Work or Drainage Proposed <br /> Approved By: Date: /2,/202,1 Ij DBackflow Prevention for high hazard: <br /> 1(dental,medical,animals,mortuary,hospital, <br /> !supportive housing) <br /> FIRE DEPARTMENT El 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 ❑Deferred <br /> Additional Notes: p.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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved Bye ,) "i Date: 313e l u 1 I <br />