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111 <br /> Intake &Approval 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 �:' Attach to Project No. Req fi Li —043 btsiAlio' <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 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ON. ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update sting ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Req ' ed: "In Lieu"Fee:Type: Amou '$ <br /> Fire Alarm: ❑up.ate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alar • 'equired: Calculated: Credit: <br /> RCW 64.55 MF , orksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo chool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Des ❑No Additional Notes: <br /> / <br /> VALUATION CALCULATION: Total$ 5o ,cref <br /> Approved By: ‘1_. C a,. Date: 6 .\4. N <br /> PUBLIC WORKS- <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 'PW Worksheet Needed if: <br /> OSys Dev Eval ❑Traffic Mit Eval <br /> c;l4r1e7-- ,1 ❑Site Work or Drainage Proposed <br /> Approved By: / - Date:6/1/U/ -/ 0Backflow 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 ❑Deferred <br /> Additional Notes: .: ❑This Permit is Approved by Public Works <br /> 0 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 0 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 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL NO P,e., <br /> Additional Notes: <br /> Approved By: Date: Approved ! 'O Date: <br />