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Intake &Approval Sheet 1110 (FOR PERMIT STAFF ONLY) • PERMIT# �36()I''0Za <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: . <br /> Intake Comments: Intake Comments: <br /> El 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 /> Bldg/TI/Addn/Rem Size /S)6, 4P ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone t' <br /> Number of Stories / "V Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction V — B Residential Use <br /> Occupancy Group m� S—f Proposed No.of Dwelling Units: <br /> Occupancy Load , - '// Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System NNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System Mot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ['Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ISINo Additional Notes: <br /> VALUATION CALCULATION: Total$ VI/Oc2er <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 4 NCI WIC a 4f2 ka) Intake Comments: bPW Worksheet Needed if: <br /> 5-70-w--, )7 7amiTTL O I❑Sys Dev Eval OTraffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> / <br /> Approved By: �L' Date: al /J�l i 1 OBackflow 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 I 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 El Deferred <br /> Additional Notes: 2 ❑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 /> 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 ElWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> L, � <br /> Approved By: �v Date: ;7-1*/?') ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 'Z',,7, <br />