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• • <br /> Intake L Approval She,-4 (F01!) PERMIT STAFF ONLY) PERMIT# 12DD\ <br /> tUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> El Route to Commercial Building El Attach to Project No. <br /> El Route to Residential Building 0 Route to Historic Reviewer <br /> El Make this a"W"Permit El OK to Route to Other Departments <br /> Bldg/TI/AddnlRem.Size 0 Hold in Planning File Drawer <br /> - <br /> Garage/Accesory Struct:Size Zone - <br /> Number of Stories Overlay/Agreement <br /> Basement EINo ElYes, 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: ElUpdate Existing EINew System EINot Req'd Planning/Landscape Inspection Required before Final? OYes EINo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing EINew System EINot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes. El No E3Everett School Dist El Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ElYes ONo Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> - )(Vb ChCIA(V6-10 (\e4 `61 it f J .(6 <br /> • Approved By: ' D te:(A Co' <br /> PUBLIC WORKS I' <br /> Intake OK by: Date: <br /> ,...............................................,....................................„.,.......,. <br /> ,.• <br /> Additional Notes: - 'Intake Comments: IPW Worksheet Needed if: <br /> i OSys Dev Eval OTraffic Mit Eval <br /> I I,....,USite Work or Drainage P ..osed <br /> • <br /> ; . <br /> I OBackflow Prevent. for high hazard: <br /> Approved By: V-rp." Date: i i'q-11 ggat) <br /> i(dental,medical,a " als,mortuary,hospital, <br /> isupportive hou • g) <br /> FIREDEPARTMENT EIRoute this folder for PW Review at end -PW Review Worksheet <br /> Separate/Deferred Submittals Required:. EIThis project also has a separate co' urrent PW Review(Green Folder) <br /> ElFire Sprinklers OFire Alarm ElOther: AND EICreate Green Folder $ ubmitted Previously EIDeferred <br /> Additional Notes: , El This Permit is Approved 0 Public Works • .,- <br /> El See PW Review W. sheet and associated attached items <br /> I Fire Dept.Fees: El A Separate PW 'ermit is Required(Permit#: PW ) <br /> El Review of As-Built Plans-NO FIRE FEE AND El Is io :ted in this folder <br /> El Minimal or No Fire Scope-NO FIRE FEE El Is. a Separate Green Folder(loin with this folder for permit issuance) <br /> El Review/Inspection Scope-ADD FIRE FEE 111 ill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 1„1 Public Works has no scope---PW Not Required <br /> t4..itional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 4 <br />