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Intake &Approval Sheet (FOR PERMIT STAFF ONL1.9 PERMIT# QO <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 /f <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 76 C, 0 Hold in Planning File Drawer /' <br /> Garage/Accessory Struct. Size .1ti e_4(),47 Zone <br /> Number of Stories f Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction V 3 Residential Use <br /> Occupancy Group V' Proposed No. of Dwelling Unit-. <br /> Occupancy Load YL 1)6' Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System ONot Req'd Planning/Landscape I pection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ❑New System Not Req'd School Impact F-•: Total $ <br /> Reason Fire Alarm Required: ,-y Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes L7 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yeso Additional Notes: <br /> VALUATION CALCULATION: Total$ I.Oj Qac, <br /> Approved By: Date: , ZOIC <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 /> DSite Work or Drainage Proposed <br /> Approved By: Date: l ' 9 0""/ ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously El Deferred <br /> OSending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DUpdate Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW <br /> Fire Alarm: DUpdate Existing ❑New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: DUpdate Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ❑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 /> Al <br />