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w i Z <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �✓ 2b2- O� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:6de Assign To:ri las 1 • Date:Zt t"1 I20202/ <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit M OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size I $ 7 6 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size -- Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement ifiNo DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction jf /3 Residential Use <br /> Occupancy Group 1u Proposed No.of Dwelling Units: <br /> Occupancy Load L( �! Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System alot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update ExistingNew 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? ❑Yes Ito DEverett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? n❑Yes wlvo Additional Notes: <br /> VALUATION CALCULATION: Total$ ZD,(9DD.°-9 11)11A1 `40 <br /> .eyeshf/f)-Kol <br /> Approved By: bate: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PWWorksheet Needed if: <br /> ['Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By: Date' ✓PZ €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 /> ❑Fire Sprinklers ❑Fire Alarm DOther: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: Eg This Permit is Approved by Public Works <br /> laSee PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: El A Separate PW Permit is Required(Permit#: PW Z20 2 Cl2.. ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND I-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 /> JaReview/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:IV—.., MAJVN Date: q_t q- 2,2 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By. Date: ¢I t Z (�►2.t <br />