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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Y W .fa7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <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 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone C:2._ <br /> Number of Stories 2. Overlay/Agreement �p r ' <br /> Basement ❑No DYes , Fin/Unfin Nonresidential Use e -r-t-'l C.-e_ /jA)S p•-- <br /> Type of Construction y(- 1%• Residential Use _ <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 2. Total No.of Dwelling Units: <br /> Fire Sprinklers:soUpdate Existing ❑New System :Not Req'd Planning/Landscape Inspection Required before Final? DYes LJ 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? ❑Yes ® No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes rkNo Additional Notes: <br /> VALUATION CALCULATION: Total $ ad50 <br /> Approved By• Date: 3/z.6,/Zo <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 /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: 4W t, (o ❑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 /> DFire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 /> O Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> Igt Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K 6 et,W}1 Date: y--Al/9Public Works has no scope---PW No Required <br /> Additional Not /, y' I to 120 t q <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: 1- <br /> I. <br /> czi;.i <br />