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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0S r-o(24"-- <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 ?j <br /> Number of Stories Overlay/Agreement G127 <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes,No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El 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 0 No ❑Everett School Dist ❑Mukilteo Sc of Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional_ Notes: ' l3 �p( O t'C <br /> VALUATION CALCULATION: Total $ (Q-foalJk( y 2 wc- OY �WJ <br /> M ' <br /> Approved By: �( Date: j- - <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 'Wt•Mo.. tea. svitv.retkmcnMra4 Intake Comments: PW Worksheet Ne dedif: <br /> c> ❑Sys Dev Eva ❑Traffic Mit Eval <br /> / ❑Site Work ., Drainage Proposed <br /> Approved By: Date: v/�/19 ❑Backflo Prevention for high hazard: <br /> /// (dental, dical,animals,mortuary,hospital, <br /> support e housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at e ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate c. current PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder 0 bmitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by P blic Works <br /> 0 See PW Review Workshe- and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit'• Required(Permit#: PW <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in t s folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Sep. .te Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be is- ed separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works as no scope---PW Not Required <br /> Additional Note-. <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> E <br />