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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# tom ®to\ <br /> BUILDINGPLANNING <br /> s//t//9 Intake OK : Date: <br /> Intake OK by: Date: by: <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 /> BldgITl/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage// sort' truct.Size Zone g—2- <br /> Number <br /> Number of$torles / Overlay/Agreement <br /> Basement KNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 5 - <br /> Occupancy Group Vc Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: - "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing New System El 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 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes INo Additional Notes: <br /> VALUATION CALCULATION: Total $ 8o2s <br /> Approved By: U"e' Date: 5/11/� ! <br /> PUBLIC WORKS <br /> Intake OK by: T'- Date: 5/l 4-/24=1/ <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> hlv µo <br /> —DE LNC. ❑Sys Dev Eval ❑Traffic-Mit Eval <br /> ❑Site Work or Drainage Proposed tyd <br /> ' No S.s <br /> Approved ByJ I maw Date: CILI k °\ ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> ntn 491‘141,5 supportive housing) <br /> FIRE DEPARTMENT ►17- -lute 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: V'= This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑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 Goin with this folder for permit issuance) <br /> O 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 Date: 5 t 20/ <br />