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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#1ii2't OLS —Orl 3 <br /> BUILDING PLANNING <br /> Intake OK by: L/... 3 /. -i��S Intake OK 1 ..c:PAssign To: .fir'_ Date: 'S 17_.'LI <br /> Intake Comments: Intake Commen s: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldgf'I"`/kddn/Rem Size /v00,IF 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size A/b Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ISI.No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction nfree Residential Use 5-ea ) ic- \ <br /> Occupancy Group ./_C Proposed No.of Dwelling Units: ` <br /> Occupancy Load I r Total No.of Dwelling Units: 'f\.'e.. <br /> Fire Sprinklers: ❑Update Existing ❑New System psiNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$_ - <br /> Fire Alarm: ❑Update Existing ❑New Systemot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: IIsSa� Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes GTNo ❑Everett Sc ist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ,No Additional Notes: <br /> VALUATION CALCULATION: Total $2.5, OG°, 60 <br /> Approved B, . Date: 2 ` ,2,02.Z. <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> L _,4- Date: �' / `.n2� ❑Backflow Prevention for high hazard: <br /> Approved By <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 /> CI Fire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: .This Permit is Approved by Public Works <br /> El See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 'A Separate PW Permit is Required (Permit#: PW'203 -005 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Ei Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 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 <br /> Additional Notes: <br /> Approved By: Date: Approved By: N, 'TA8 Date: 3/I1 j'3ZZ <br />