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Ash <br /> 0 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#91,Cl n9:X.0Z 3 <br /> BUILDING PLANNING <br /> Intake OK by:_ 4 Date: (4 i'i 100) Intake OK by: 4 Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> El Route to Commercial Building ElAttach 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 <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 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 El No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing Chew 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? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total $ gel(9)f. <br /> Approved By: -72. Date: A Utr._As� 1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: r Rv cav Az ' szi"74keJh- Intake Comments: PW Worksheet Needed if: <br /> `4.`4-.,4 , ❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: Date: � � t q (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 /> El 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 /> JQVVlinimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder Qoin 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:1<.'?O2 Q 0 Date: gam?-/q it::_- blic Works has no sco a---PW Not Required <br /> Additional Not <br /> _ ELECTRICAL g/23/Z0t9 <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />