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/Dt4 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# LJ `� — D2 <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/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 DYes , 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: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <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? DYes ❑ No ❑Everett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes 0 No Additional Notes: 56e,/- /,(P--0 23 <br /> VALUATION CALCULATION: Total $ <br /> Approved Date: q /7 <br /> PUBLIC WORKS //// <br /> Intake OK by:,JE Date: y/s/Z6/7 <br /> Additional Notes: Intake Comment: PWWorksheet Needed if:• <br /> � , m ❑Sys Dev Eval ❑Traffic Mit Eval <br /> SH-51 / G DSite Work or Drainage Proposed <br /> Approved By: Date: 7�[ 4 ❑Backflow Prevention for high hazard: <br /> (��� (dental,medical,animals,mortuary,hospital, <br /> De , ( supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: DThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm DOther: AN ❑Create Green Folder OSubmitted Previously ❑Deferred <br /> Additional Notes: 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 /> 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 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: r-! Date: if/ Or <br />