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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#c 2c -co( <br /> BUILDING PLANNING <br /> Intake OK by: Date: Inta . OK by: Assign To: Date: <br /> Intake Comments: Intake '•mments: <br /> ❑ Route to Commercial Building ❑ Attach to Proj- t No. <br /> ❑ Route to Residential Building ❑ Route to Historic "eviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Othe Departments <br /> Bldg/TI/Addn/Rem Size tC6 AO 0 Hold in Planning File D -wer <br /> Garage/Accessory Struct.Size ---"- Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement lEINo DYes, ddFiin/Unfin Nonresidential Use <br /> Type of Construction `'�/A Residential Use <br /> Occupancy Group E Proposed No.of Dwelling Units: <br /> Occupancy Lo C Total No.of Dwelling Units: <br /> Fire Sprinklers: pdate Existing ❑New System ONot Req'd Planning/Landscape Inspection Required be'ore Final? ❑Yes ❑No <br /> Reason Sprinkl-rs�,Required: "In Lieu"Fee:Type: Amo t$ <br /> Fire Alarm: J 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? ❑Yes 'No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes '1No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: L Date: <br /> PUBLIC WORKS <br /> Inta' • OK by: Date: <br /> Additional Notes: _, ���� Intake ments: PW Worksheet Needed if: <br /> a- ��;� ?1 l — ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 1�l�TT /fJ J4)4 ❑Site Work or Drainage Proposed <br /> Approved By: li� Date: <br /> / // ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Re,'ew at end ---PW Review Worksheet <br /> Sep. ate/Deferred Submittals Required: OThis project also has a separat- concurrent PW Review(Green Folder) <br /> DFire ,.prinklers ['Fire Alarm DOther: AND ❑Create Green Folder ❑Sub ,itted Previously ODeferred <br /> Additional .tes: 0 This Permit is Approved by Public Wo s <br /> ❑ See PW Review Worksheet and associat-• attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: -W ) <br /> 'Review of As-Built -tans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Sc..e-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folde or permit issuance) <br /> 0 Review/Inspection Scop- -ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,P 'ssued ahead of Bldg) <br /> Approved By: Date: 16 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: '�� Date: Approved By: )L� ' Date: <br /> 2/. <br />