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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# -2'.,0 J o t VV <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:1 , Assign To}te> 13 , 1 ! I 'I-1 I <br /> Dater <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 e OK to Route to Other Departments <br /> Bld(e•dn/Rem Size /$00 i "f 0 Hold in Planning File Drawer �I <br /> Garage/Accessory Struct.Size NM Zone L I <br /> Number of Stories I Overlay/Agreement _ <br /> Basement No ❑Yes, Fin/Unfin Nonresidential Use WkreArICAAe. <br /> . Type of Construction gs Residential Use <br /> Occupancy Group N Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: Pupdate Existing ❑New System CI Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes MO o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: &update Existing CI New System DI Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? Dyes allo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 does required prior to final? ❑Yes , Vo Additional Notes: <br /> VALUATION CALCULATION: Total$ Y? Sod <br /> Approved By: A Date: )))0211 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: DPW Worksheet Needed if.: <br /> I❑Sys Dev Eval DTraffic Mit Eval <br /> i=DSite Work or Drainage Proposed <br /> Approved By: Date: p�i/y®z, ❑Backflow Prevention for high hazard: <br /> i(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 /> 1 <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 /> ❑ inimal or No Fire Scope-NO Fl E FE / <br /> CI in a Separate Green Folder(join with this folder for permit issuance) <br /> Review/I p Scope-.ADD ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Appr Vv Date: ,. r2P2_ ►�� Public Works has no scope---PW Not Required <br /> v Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: PM Date: 1(2212 <br />