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4111 i <br /> Intake Lz, Approval She"-t (FOR PERMIT STAFF O i1,10 PERMIT# 2OO\- O\ S- <br /> _,UILDING PLANNING <br /> Intake OK by; Date: Intake OK by: Assign To: Date: <br /> Intake Comments: <br /> Intake Comments: <br /> ® Route to Commercial Building ® Attach to Project No. <br /> ® Route to Residential Building 0 Route to Historic Reviewer <br /> ® Make this a "W"Permit L..1 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.ofDwelling-Units:_ - —_-.— -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: ®Update Existing ®New System ®Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: - Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes. ® No ®Everett School Dist ®Mukilteo School Dist <br /> ,Addi RCW 64.55 docs required prior to final? DYes ®No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> \Tad/Q/1(1/1(411°k r\eid <br /> • <br /> • Approved By: D tea 6kI , <br /> PUBLIC WORKS <br /> l Intake OK by: Date: - <br /> Additional Notes: Intake Comments: tPW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> =DSite Work or Drainage P :.osed <br /> Approved By: Dater DBackflow Preventi. for high hazard: <br /> :(dental,medical,a . als,mortuary,hospital, <br /> i <br /> isupportive hou " g) <br /> FIRE DEPARTMENT - I'®Route this folder for PW Review at end -PW Review Worksheet <br /> Separate 1 Deferred Submittals Required:. {®This project also has a separate co• urrent PW Review(Green Folder) <br /> ®Fire Sprinklers ®Fire Alarm ®Other: AND ®Create Green Folder _f" ubmitted Previously ®Deferred <br /> Additional Notes: 0 This Permit is Approved . Public Works . <br /> 0 See PW Review W. sheet and associated attached items <br /> Fire Dept.Fees: El A Separate PW -ermit 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 El Is' a Separate Green Folder(loin with this folder for permit issuance) <br /> ® Review/Inspection Scope-ADD FIRE FEE I ill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ITS Public Works has no scope---PW Not Required <br /> 3 .itional Notes: <br /> ELECTRICAL <br /> ;Additional Notes: <br /> Approved By: Date: Approved By: - - Date: <br />