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Intake & Approval Sheet ' (FOR PERMIT STAFF ONLP PERMIT a2,06 l �t <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑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 /> BldgOAddn/Rem Size /5q/ ,S` 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories 2 ALc ' Overlay/Agreement <br /> Basement L.No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use S'r <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load N/4 Total No.of Dwelling Units: G <br /> Fire Sprinklers: ['Update Existing ❑New System ['Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes roNo <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? ❑ IS( <br /> Yes ua(No ❑Everett School Dist ❑Mukilteo hbol Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ /59,fDa <br /> `//W-44 /Srcj/ $ .SQ.Fr <br /> Approved By� Date: CY,VT,2.0t0 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 29/5 / C 0 INJ C Intake Comments: IPWWorksheetNeededif: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: 4 ❑Backflow Prevention for high hazard: <br /> _(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/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑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 ❑ 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 /> 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: B¢WZotc1 <br /> �/L <br />