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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# V:Dl\9Cq —C <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <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 /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone C.. <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use sr�4�- �ti,1,h) <br /> Type of Construction Residential L!se <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ONew System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes RNo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ �, <br /> Fire Alarm: El Update Existing El New System ❑Not Req'd School Impact Fee: Total $ !� <br /> Reason Fire Alarm Required: Calculated: Credit: V <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilte, drool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total $ <br /> Approved By: y/ 1�.{;�y� Date: C I C . I <br /> r (,PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPWWorksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffc Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: Date: �, �.==r <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: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers El 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(join with this folder for 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: E Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL 19�; , V UM 0 "- d <br /> Additional Notes: ,/ Ml 1 n Y`C�jf <br /> Approved By: Date: Approved By: r Date: <br /> v (�, <br /> 7)Z <br />