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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# g 2JO g <br /> BUILDING PLANNING <br /> f <br /> Intake OK by: Date: /. 06/ 74 Intake OK by: Assign To: Date: <br /> Intake Comments: / Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> n.Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI69/Rem Size 6 7-/ FtZ ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories 2- Overlay/Agreement <br /> Basement 2allo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 1it2C rr Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System I�tNot 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 ❑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? ❑Yes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ElNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 'V/ ©©6 ✓/ ✓� <br /> p I Lt c. 1-tcry b <br /> Approved By: Date: <br /> . PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if. <br /> OSys Dev Eval OTraffic Mit Eval <br /> IOSite Work or Drainage Proposed <br /> Approved By: /2,�l� - Date: 3fi 3i#2c 22 <br /> �OBackflow 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 /> El Fire Sprinklers ❑Fire Alarm ❑Oth- . AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> I -See PW Review Worksheet and associated attached items <br /> 1 <br /> Fire Dept. Fees: IYA Separate PW Permit is Required (Permit#: PW 1203-ot U <br /> ❑ Review of As Built P� NO FIRE FEE AND located in this folder <br /> ❑ Minimal or N• Fi se-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/I . • ion 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 /> Addiional Notes: <br /> • •proved By: Date: Approved 13y.- Date: ,.i i <br />