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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# vi 06 -0 (1 <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/TIJAddn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone C- J2. <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use -f'D I r C-e pip-}' gt)ric t <br /> Type of Construction Residential Use U <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 F'- - ? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: • •unt$ <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? ❑Yes 0 No ❑Everett School Dist ■Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0N Additional Notes: <br /> VALUATION CALCULATION: Total$ S)d 000.00 <br /> Approved By: G/ Date: (p/i4/19 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By,es� Date:dj6 lizolq ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I 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: 0 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 /> ❑ 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: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> ( <br />