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411, <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# 13-1111 -0 l • i <br /> BUILDING // PLANNING <br /> (Q Intake OK by: Date: II t Intake OK by: Assign To: Date: <br /> Intake Comme Intake Comments: <br /> ❑ Route to Commercial Building 0 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 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Oyes , 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 ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System CI 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 ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 132-1 b Cc <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> 1 <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: �/ IL <br /> ❑Backflow Prevention for high hazard: <br /> ;(dental,medical,animals,mortuary,hospital, <br /> r <br /> (supportive housing) <br /> FIRE DEPARTMENT Nick �) El Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: v ❑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: <br /> ❑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 0 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 /> 129 Review/Inspect'on Scope-ADD FIRE FEE ElWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: 3t Date: Z`�// Public Works has no scope PW Not Required <br /> ( l Additional Notes: <br /> ELECTRICAL n 0 ['4v 0 <br /> Additional Notes: 9� J <br /> Approved By: Date: Approved By: Date: <br />