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Intake &Approval Sheet - (FOR PERMIT STAFF ONLY) PERMIT# 132-t°1 O a4- <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone �T <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use (;)/tAN & 11.‘5CL4 <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: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Require. _- ore Final? DYes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New 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? DYes ❑ No DEverett School nest ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> 5-Ap.Z tZ-- <br /> Approved By Date: tg'"1 <br /> PUBLIC WORKS / <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if: <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> 3DSite Work or Drainage Proposed <br /> Approved By: \ Date: �2p�27i '❑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 El Fire Alarm ❑Other: AND Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: , his Permit is Approved by Public Works <br /> ,,,L iSSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: LYA Seep ate PW Permit is Required(Permit#: PW`ZlO ' alb ) <br /> El Review of As-Built Plans-NO FIRE FEE AND IM 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: Kan,ce fn Date:8 —,„2/ ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: y Date: L 0 V Z Zi <br />