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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) di PERMIT# ?l P'LLD <br /> BUILDING . _ PLANNING • • . • - <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> f I tt n s old Ad-f--tvte7-vw ev;n4.JYI/1 rely;rem/vita; <br /> ° Co(cecf4 I e er or'tf- Irt 1/2-Q/ . <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Mak is a" "Permit 0 OK to Route to Other Departments <br /> Bldg/II/Ad hemW ze ZSZ , , (pi;c%) ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone '",S <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Ekes, Fin/Unfin Nonresidential Use . <br /> Type of Construction - rde. Residential Use Sew <br /> Occupancy Group (r Proposed No.of Dwelling Units: <br /> Occupancy Load • • Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System tONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes Cho <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System fEkNot Req'd School Impact Fee: Total $ , <br /> Reason Fire Alarm Required: 1�7 Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 71 No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes -4ZINo Additional Notes: <br /> VALUATION CALCULATION: Total$ F 900,00 <br /> Approved By: Date: 4/ 70 ' <br /> PUBLIC WORKS'. <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> ❑Sys Dev Eval DTraffic Mit Eval <br /> • <br /> . ❑Site Work or Drainage Proposed. <br /> Approved Byw Date:0 Si/r/ Z___ f❑Backflow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> - . FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: i ❑This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ 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: Nt Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Ammilowxl By:A6 I 4-7—Seract.7• Date: ©5PI2 iI10Zt✓ <br />