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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# b`a03 _oLE3 <br /> BUILDING PLANNING <br /> Intake OK by Date: DPZ jI/L(I/.' 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 0 I <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use &AUL, <br /> Type of Construction E- 4 Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Lod r Total No. of Dwelling Units: <br /> Fire SprinklersUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes to <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: IILIUpdate 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? ❑Yes i No ❑Everett School Dist ❑Mukilteo S ooI Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes tlNo Additional Notes: I v\`iiii Ls) onto),A( A,O_Q 4V <br /> VALUATION CALCULATION: Total$, 3c7Oux) e '4 <br /> Approved By: ..4n C, Date: '--Z1-19 <br /> PUBLIC WORKS <br /> Intake OK by: Date: r <br /> Additional Notes: Intake Comments: PW Worksheet Needed' <br /> ❑Sys Dev Eval ■ raffic Mit Eval <br /> ❑Site Work or Dr. age Proposed <br /> ?)..+W Date' ^ ❑Backflow Pr ention for high hazard: <br /> Approved By: `/f t/i (dental,med''.I,animals,mortuary,hospital, <br /> supportiv- ousing) <br /> FIRE DEPARTMENT El Route this folder for PW Review at ens ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate c' current PW Review(Green Folder) <br /> ❑Fire Sprinklers El Fire Alarm DOther: AND ❑Create Green Folder ' ubmitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved b 'ublic Works <br /> 0 See PW Review Work- eet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Pe, it is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is locate,. in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in . Separate Green Folder(join with this folder for permit issuance) <br /> Review/Inspection Scope-ADD FIRE FEE 0 W' be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ,9j-096,/n Date:IL/.-/.4'/q 0 Publi• orks has no scope---PW Not Required <br /> Additi' al Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />