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A14 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY '" ERMIT# �'��� q <br /> /BUILDING PLANNING <br /> Intake OK by: ` Date: t i� _ Intake OK by: Assign To: Date: <br /> Intake Commen : —raie,K kt4Fr Intake Comments: <br /> Q& R E:Fca --r t,1 �1owl Qu.4r. <br /> -ritom Liel.A.cmi elir..47mciA. <br /> Al Route to Commercial Building (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 0 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 ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System El 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 does required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: <br /> g �PUBLIC WORKS <br /> Intake OK by�,�e%;I C6 Date: l 7.Q}fre) <br /> Additional Notes: 'gmt r�-oa.4- Intake Comments: =PW Worksheet Needed if: AM <br /> sracrsscr <br /> Q - ,� �11D 1ro.,-.A.o, ti a .r, 'Mid <br /> Dev Eval ©Traffic Mit Eval <br /> " �� ❑ <br /> I oSite Work or Drainage Proposed <br /> Approved By: Date: I OBackflow Prevention for high hazard: <br /> l (dental,medical,animals,mortuary,hospital, <br /> / / ;supportive housing) <br /> `—*IRE DEPARTMENT El 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 ❑Create Green Folder ❑Submitted Previously CI Deferred <br /> Additional Notes: , 0 This Permit is Approved by Public Works <br /> 0 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 /> 0 Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder Goin with this folder for permit issuance) <br /> 0 Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: �{ <br /> Approved By: Date: Approved By:L..,2S v Date: 1 /20/7„6/9 <br />