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• <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2—e <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 0 OK to Route to Other Departments <br /> Bld /Tf/ ddn/Rem Size 7/Z 5F ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size NV/"A Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement pNo ❑Yes , Fin/Unfin Nonresidential Use /} k an+� ��°� <br /> Type of Construction VA Residential Use J9' <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load /6/ Total No. of Dwelling Units: <br /> Fire Sprinklers: Update Existing El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes to <br /> Reason Sprinklers Required: "In Lieu"Fee: Type: Amo $ <br /> Fire Alarm: Update Existing El New System El 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 0 Everett School Dist 0 Mukilteo chool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: ten <br /> VALUATION CALCULATION: Total $ '- (1"T" ' .L))0(1- 01;;WI ) <br /> CAN; r /• ". <br /> Approved By: Date: 5- 2C% C> <br /> (` UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPWWorksheetNeededif: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved Bye Date: Cy/j y%j7,7c =❑Backflow Prevention for high hazard: <br /> (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 OFire 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 2-Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K (D1_,e_j n Date: 44:2/ZeiZell ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 7, <br />