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(62—kC)\ (:)(33 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 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 V- j Residential Use P(btV( ►((�(J <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑ Y�New System 1INot Req'd Planning/Landscape Inspection Required before Fin I? ❑Yes li§No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount <br /> Fire Alarm: ❑Update Existing New System UNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes 6 No ❑Everett School Dist ❑Mukilteo School ist <br /> Add.'RCW 64.55 docs required prior to final? oyes to No Additional Notes: / @r� /t, � <br /> f��j 44b O^' YID <br /> VALUATION CALCULATION: Total$ 7�(O�- _ <br /> Approved By: V.,,I \ Date: \ ,2Z,PUBLIC WORKS <br /> WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> r :❑Site Work or Drainage Proposed <br /> Approved By: Date: •j/ (p �{ ❑Backflow Prevention for high hazard: <br /> (((JJJ--_ / :(dental,medical,animals,mortuary,hospital, <br /> _supportive housing) <br /> FIRE DEPARTMENT El Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I 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: ❑ 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 /> O 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(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: Date: <br />