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Intake &Approval Sheet 11111 (FOR PERMIT STAFF ONLY) • PERMIT# �\ V'32 <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 /> Bldg/Tl/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone L2, <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use dttigkel 6fi2 <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IZINo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑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 ❑Everett School Dist ❑Mukilteo School D'st <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: at, 4o ( erir\t - CC <br /> VALUATION CALCULATION: Total$ MCl -, _ 1:17 <br /> Approved By: �L.. Date: tt_ Zv_ 2.0z4 <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: DPW Worksheet Needed if: <br /> 1❑Sys Dev Eval ❑Traffic Mit Eval <br /> r f CI Site Work or Drainage Proposed <br /> Approved By: Date: 9ThiSlaril { OBackflow Prevention for high hazard: <br /> vvv <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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ 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 El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ' r�. <br /> Approved By: t`0(,V-n Date: j /20�� -ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> jz <br />