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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# `? •c:1 0&— 1 <br /> BUILDING PLANNING <br /> Intake OK by: Date: 1 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 /> O Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bidg/TI/Addn/Rem Size -� srifi" ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone - <br /> Number of StoriesOverlay/Agreement <br /> ,,--bbyy <br /> Basement ❑No tolYes, Fin/Unfin Nonresidential Use ( C1M0.\3 9my' <br /> Type of Construction e, Residential Use <br /> Occupancy Group F-Z Proposed No.of Dwelling Units: <br /> Occupancy Load 4- Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System PNot Req'd Planning/Landscape Inspection Required ore Final? ❑Yes ®No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ❑New System El 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 LSI No ❑Everett School Dist Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes nNo Additional Notes: <br /> VALUATION CALCULATION: Total $ (#DoU• <br /> Approved By: ----` Date: J (:Tr( Zp\� <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet ededif: <br /> ❑Sys Dev-fat ❑Traffic Mit Eval <br /> ❑Site i ork or Drainage Proposed <br /> Approved By: �� Date: el-12.11tom/ DB- kflow Prevention for high hazard: <br /> U I (• ntal,medical,animals,mortuary,hospital, <br /> upportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Rev' at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a se%arate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green F. ier ❑Submitted Previously El Deferred <br /> Additional Notes: 0 This Permit is Ap. oved by Public Works <br /> 0 See PW Revie Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate 'W Permit is Required(Permit#: PW ) <br /> O Review of As-Built Plans-NO FIRE FEE AND 0 I ocated in this folder <br /> ,Minimal or No Fire Scope-NO FIRE FEE sin a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K, jW p Date: 4.-u_/q ❑ ublic Works has no scope---PW Not Required <br /> ditional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: �� <br />