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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# fbai\ bp <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 <br /> Number of Stories Overlay/Agreement <br /> Basement ENo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group f - Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: tlUpdate Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ONew 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? DYes irE No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Dyes IKINo Additional Notes: <br /> VALUATION CALCULATION: Total$ 44 DP <br /> Approved 41111161- 4( Date: /1 FM <br /> PUBLIC WORKS <br /> Intake OK by: —irip.3 Date: (t 120 120' <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> R r c c*A <br /> 12-e4-4•01:04-t- ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ua p W cc?E. ❑Site Work or Drainage Proposed <br /> Approved By: jf.V7 Date: (91(b <br /> El 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 /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW <br /> Fire Alarm: ❑Update Existing ONew System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ONew System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 4 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: // 120 '201$ <br /> Approved By: Date: Approved By: Date: <br />