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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# Z2.0tg-0� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: alc Assign To: (.5e-Ig. Date: (0/2/�72 <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" ' mitOK to Route to Other Departments <br /> Bldg/TI n/Rem ` El Hold in Planning File Drawer <br /> A/Garage/Accessory Struct. Size 7 Zone 11—a. <br /> Number of Stories Z.._ _ Overlay/Agreement <br /> Basement ❑No EYeS, Fin 6Jnf 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 ,lot 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 ONew 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 ❑Everett School Dist ❑Mukilteo School Dist <br /> Add! RCW 64.55 docs required prior to final? ❑Yes 5iNo Additional Notes: <br /> VALUATION CALCULATION: Total $ Jf L`ev%O: <br /> Approved By:A Date: 72_,/202_2_ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PWWorksheetNeededif:: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> El Site Work or Drainage Proposed <br /> Approved B Date:ie/r0/rot <br /> � ❑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 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: Date: Q Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: _ - I3/2+22 <br /> Approved By: Date: Approved By: Date: <br /> 7-/z_ <br />