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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# k1.-tv l - ©1 S <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 /> O Route to Residential Building 0 Route to Historic Reviewer <br /> O 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 ❑Yes , Fin /Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwellin; Units: <br /> Occupancy Load Total No. of Dwelling 4 nits: <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landsc. .e Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu" Fee:Ty•-: Amount$ <br /> Fire Alarm: DUpdate Existing ONew System ❑Not Req'd School Impact 'ee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett hool Dist OMukilteo School Dist <br /> Add'i RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ �6.?7d Uw <br /> Approved By: �szc Date: l `\, C\ <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 /> El Backflow Prevention for high hazard: <br /> Approved By2,9 , ,,,,,Z4-- Date:0©(/fwe, <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/Deferred Submittals Required: DThis project also has a separ. e concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ID Fire Alarm ❑Other: AND ❑Create Green Folder ❑• bmitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Publi•Works <br /> 0 See PW Review Worksheet and as.ociated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required ('-rmit#: PW ) <br /> ❑ Review of As-Built Plans- No FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope- NO 'E FEE 0 Is in a Separate Green Folder(join ith this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD Fl" FEE 0 Will be issued separately(Separate G -en Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Req 'red <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />