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Ir.take &Approval Sheet • (FOR PERMIT STAFF ONLY) . PERMIT#bn1 <br /> BUILDING G PLANNING <br /> Date:/1/&LA of Intake OK b f Jiy Assign To: ._.. t. /ZZ Gt I <br /> Intake OK by:���, y: > g ��'f�C GI Date: I) 1 �) <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building L! Attach to Project No. I le-De <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit [0OK to Route to Other Departments <br /> I/Addn/Rem Size /z.0 sr ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size M Zone —frig <br /> Number of Stories / Overlay/Agreement <br /> Basement ERINo ❑Yes, Fin/Unfin Nonresidential Use [ f1 S r+51:7 J i <br /> Type of Construction 1/6 Residential Use <br /> Occupancy Group a Proposed No.of Dwelling Units: <br /> Occupancy Load Z‘i Total No.of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System LINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes L`SNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ONew System SNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes ® No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add.'RCW 64.55 docs required prior to final? DYes No Additional Notes: <br /> VALUATION CALCULATION: Total$ `2 Si%6/ <br /> Approve: Date: / Z'7 <br /> fib/ <br /> PUBLIC WORKS ` <br /> Intake OK by: Date: /�/ 2 2-- <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> l3Sys Dev Eval 7❑Traffic Mit Eval <br /> Site Work or Drainage Proposed q <br /> Approved B Date: vZ7 €❑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 /> ❑Fire Sprinklers El Fire Alarm ❑Other: AND ®Create Green Folder ❑Submitted Previously ['Deferred <br /> Additional Notes: his 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 0 Is in a Separate Green Folder(join 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 B Date: /Zb/40/ <br />