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v l (FOR PERMIT STAFF ONLY) • PERMIT# 2 ZO I — 0 S1 <br /> Intake &Approval Sheet <br /> BUILDING PLANNING <br /> Intake OK by: 14- Date: 10 l Intake OK by: Assign To:-j71(J ., Date: 2-IL�-� <br /> Intake Comments: Intake Commen s: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bld /Tibia. i'- v <br /> g ��a �l'1 � Wz(H!/IJ G-xtsnlvrn El Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,Iv/ft- FteretAW Zone -�Z-- <br /> Number of Stories 1 Overlay/Agreement <br /> Basement 17iNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction �✓�- Residential Use Sf12— <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing El 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 El New System pNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ENo Additional Notes: <br /> VALUATION CALCULATION: Total$ Z� <br /> Approved By: Date: Z•Z . 3, 2.2 <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: 8411/04:9- t'� wtrllrr/ -) Fecirpep r Intake Comments: IPW Worksheet Needed if:--- .- <br /> OSys Dev Eval ❑Traffic Mit Eval <br /> lDSite Work or Drainage Proposed <br /> Approved By: 4j Date: 240/Lm22 _DBackflow Prevention for high hazard: <br /> _(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT DRoute 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 0 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />