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Intake & Approval Sheet (FOR PERMIT STAFF ONL� PERMIT#��,o��(Z�,.� �V <br /> `BUILDING` PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ,,�.�v��{d �► ��30/r9 s/� �� <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bld I/ ddn/Rem Size /Z I�DD �� ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size N� Zone <br /> Number of Stories i(/✓� Overlay/Agreement �,S�C� �!? <br /> Basement No ❑Yes, Fin/Unfin Nonresidential Use 1'1/1�!?I�l Y1�1 <br /> Type of Construction ,(3 Residential Use <br /> Occupancy Group f Proposed No.of Dwelling Unifs: ---�-» <br /> Occupancy Load �� Total No. of Dwelling Units: <br /> Fire Sprinklers: pdate 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: ❑Update Existing ❑New System �Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: 0 �fi��4�/«=S 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 No Additional Notes: �-----�---� � jfl� <br /> VALUATION CALCULATION: Total$ V�d U�d•�Q �(�� <br /> � � / <br /> Approved B • Date: ?�.11 � <br /> _ _ _ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> •----------------------------------------- <br /> Additional Notes: Intake Comments: ;PW Worksheet Needed if.• <br /> ;❑Sys Dev Eval ❑Traffic Mit Eval <br /> ;❑Site Work or Drainage Proposed <br /> Approved B Date: �,S" � � �OBackflow Prevention for high hazard: <br /> �(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> '----------------------------------------- <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/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: ❑This Permit is Approved by Public Works <br /> ❑ 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder�oin witn tt,is foidertor permit issuance) <br /> �-Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: �"�' ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL ri�t-""�'��++�� T'Er�...�►.-� tt�p.'o �cci- G�rr.� <br /> �Sc�.¢,�►�� �it�..R.,t o�s <br /> Additional Notes: S <br /> Approved By: Date: Approved By: Date: <br /> �-- <br />