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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#•()YJ Vv ta(VOI <br /> BUILDING PLANNING <br /> Intake OK by: Date: _ _ Intake OK byI2 Date: J , 'S. 2e) �( <br /> � <br /> Intake Comment. 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 '7-4 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 ❑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 In section Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fe-. Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett Scool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional •tes: <br /> VALUATION CALCULATION: Total $ <br /> Approved ByC_ -� Date: . <br /> , .S ‘,,C;.to <br /> �� PUBLIC WORKS, <br /> Intake OK by: <`5' Date: 3/'3/ <br /> ��. Q20/f <br /> Additional Notes: Intake comments: PW Worksheet Needed if: ,p F5,06 <br /> � ��,�,lJ�� Qg,•�Rau ❑ ❑ <br /> Sys Dev Eval Traffic Mit Eval <br /> 77:x/] I?a.Mo i€-ic t' Kite Work or D�dindye Piupused <br /> Approved By Date �-/ I q 'i j /���yyyy/�k I'iG+R OBackflow Prevention for high hazard: <br /> L 1�i, 7410A 44 (dental,medical,animals,mortuary,hospital, <br /> itla r.-o A S'15ZGzieutir supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND'Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: l` 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 ❑ 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 ❑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: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved Byi <br /> � � Date: 4012‘,/Z0/9 <br />