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Intake Approval • 2io -op <br /> & Sheet (FOR PERMIT STAFF ONLY) PERMIT# <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 ❑ Route to Historic Reviewer <br /> ❑ Ma a this a"W" Permit El OK to Route to Other Departments <br /> BI g/T Addn/Rem Size /30 0 0 ❑ Hold in Planning File Drawer <br /> Garage/AccessoryStruct.Size ---- <br /> / Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ,iNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction v Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load / Total No.of Dwelling Units: <br /> Fire Sprinklers: Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <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? ❑Yes -1ErNo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IliNo Additional Notes: <br /> VALUATION CALCULATION: Total $ ` '11 =T O 1'b k-ed <br /> /3Qo <br /> k /,7-C fi Approved By: ,L_• I Date: 3 . 'S.Z <br /> C� BLIC WORKS <br /> `� -i 3C1 Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Z^�� _S Date i" �/Y / `❑Backflow Prevention for high hazard: <br /> r :(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 /> 'IfEire Sprinklers re 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: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> 0 Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder Qoin 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:\,tjrowyn Date: 3-57'/ p -ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: 1 <br />