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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Ci 6101-1 b 2' <br /> IBUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> O 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 /> - - w <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement Cho ❑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 ❑NotReq'd Planning/Landscape Inspection Required before Final? DYes I�d'lUo <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? DYes 0 No DEverett School Dist DMukilteo School Dist <br /> Add'l RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved B N Date:7//1(//g <br /> PUBLIC WORKS <br /> Intake OK by: Date: . <br /> Additional Notes: 'FE\/I ew ED Ftp c wpack Intake Comments: PW Worksheet Needed if: <br /> 't,Rmm=rt.t- .(r.,t,,,,,ni.2F,.i r7 ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> r ❑Backflow Prevention for high hazard: <br /> Approved By: Date: I;2,r}I I (dental,medical,animals,mortuary,hospital, <br /> // supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end --PW Review Worksheet <br /> Separate/Deferred Submittals Required: OThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: =4 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 /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> O 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 Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: < Gl/tA, er, for jcAyr* <br /> ELECTRICAL <br /> Additional Notes: <br /> 4.dt �S <br /> Approved By: Date: Approved BY Date: �$ <br />