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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#�kc:(04 — CO9 <br /> BUILDING PLANNING <br /> Intake OK by: ?7 <br /> Date: lQ Intake OK by: Date: <br /> i <br /> Intake Comments: Intake Comments: Assign To: <br /> El Route to Commercial Building ' 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> 0 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 ,/ <br /> Number of Stories Overlay/Agreement ,/r <br /> Basement ❑No IIes, Fin/Unfin Nonresidential Use // _ <br /> Type of Construction Residential Use / <br /> Occupancy Group Proposed No. of Dwelrfig Units: <br /> Occupancy Load Total No.of Dwelli Units: <br /> Fire Sprinklers: ❑Update Existing ONSystem ❑Not Req'd Planning/Lands ape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: pe: Amount$ <br /> Fire Alarm: ❑Update Existing 0 ew System ❑Not Req'd School Imp t Fee: Total $ <br /> Reason Fire Alarm Required: Calculate . Credit: <br /> RCW 64.55 MF worksheet req'd for per t? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to ?nal? ❑Yes 0 No Additional Notes: <br /> VALUATION CALCULATION: To 1=I$ (]� <br /> ,./.. �' <br /> Approved Bye —'--" Date: 1-1 .CA, tQAq <br /> 4.) \ .. <br /> PUBLIC WORKS <br /> Intake OK by:__PA Date: © `fc <br /> Additional Notes: Intake Comments: PW Worksheet Needed if' <br /> OSys Dev Eval G raffic Mit Eval <br /> ❑Site Work• Drainage Proposed <br /> Approved By: Date: ❑Bac. .w Prevention for high hazard: <br /> (d-- al,medical,animals,mortuary,hospital, <br /> upportive housing) <br /> FIRE DEPARTMENT , El Route this folder for PW - iew at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also ha . separate concurrent PW Review(Green Folder) <br /> *ire Sprinklers FIFire Alarm ❑Other. AND ❑Create -en Folder. ❑Submitted Previously ODeferred <br /> Additional Notes: hs ,0�,, 0 This Pe it is Approved by Public Works <br /> 0 S PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> 0 Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Review/Inspection cope ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: cc/. ,ti Date: y//d l/f Ej Public Works has no scope---PW Not Required <br /> / Additional Notes: <br /> ., ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />