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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 2"2'e)5 -6 v <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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone V i 1_ <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use etAr)IA-(7'111) <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: El Update Existing El New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes)PNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ID New System El 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 does required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: y Date: 5.)�.7 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheef Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> 1 OSite Work or Drainage Proposed <br /> Approved By: \5 ' Date: tnl wr ao Zy' £OBackflow Prevention for high hazard: <br /> i(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 /> El Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: IN This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items ML(A <br /> Fire Dept.Fees: 13 A Separate PW Permit is Required (Permit#: PW 2U —02 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ra 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: ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING0 rig C I Mi <br /> Additional Notes: yD Si 'W 6 ' W,sG 51Z6. <br /> Approved By: Date: Approved By: ��_1 V <br /> (xW �Date:,o rj la'�1fa-Y <br />