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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# B2) 1Q 012 <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: - Intake Comments: <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 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ' W Ls111' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size "" Zone v\!&,(S <br /> Number of Stories Overlay/Agreement <br /> Basement o ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction '"' Residential Use 1 \-- <br /> Occupancy Group 64 Proposed No.of Dwelling Units: <br /> Occupancy Load !`hsc Total No.of Dwelling Units: <br /> Fire Sprinklers: 0 Update Existing ❑New System (0Not Req'd Planning/Landscape Inspectio -equired before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing likew System ❑Not Req'd School Impact Fee: To . $ - <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? Oyes EAo ❑Everett School ',1st ❑Mukilteo School Dist <br /> Addl RCW 64.55 docs required prior to final? ❑Yes to Additional Note-. <br /> VALUATION CALCULATION: Total$ ,540147GV <br /> Approved B4:2) Date: \,\� tell, <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> / ['Sys Dev Eval Traffic Mit Eval <br /> 4' Mite Work or Drainage Proposed <br /> Approved By: i - Date: //. 7/A)-- DBackflow 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 ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ElA Separate PW Permit is Required(Permit#:PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 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 DIWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved Byj�.74S 1-J$ i -8 lPublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: �, Date: i 1.16: 769 <br />