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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# V I 1\� l 0'0 <br /> BUILDING PLANNING <br /> Intake OK by: r Date: � lQ Intake OK by ' Assign TolOACe Q Date: \\-\, A,t <br /> Intake Commen Intake Comments: <br /> INI{koon \re)N �s,`,�q ;tee, Sc t-9-R n 1 , <br /> 14 Route to Commercial Building% P/S ❑ 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 ❑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 El New System ❑Not Req'd Planning/Landscape Inspect'.n Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Fee: atal $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett Schoo I ist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Not: : <br /> VALUATION CALCULATION: Total$ <br /> Approved By�= - Date: \/..02 Z0ICI <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 /> (0//.,� 0�' 0 0� DSite Work or Drainage Proposed <br /> Aproved By: Date: A'C{) I❑Backflow Prevention for high hazard: <br /> i(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 El Fire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously El 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 s r PW issued ahead of Bldg) <br /> Approved By: Date: Public Works has no scope --PW Not Required <br /> dditional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2t2 <br />