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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# B Z 1 05- 00(o <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: �g, Date: 5 /0/2G� <br /> Intake Comments: Intake Comments: / <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ R ute to Historic Reviewer <br /> El Make this a"W"Permit � to Route to Other Departments <br /> t Bl. ddn/Rem Size (C17 u`Q OK❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone tL—Z <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No JYes , Fin/Unfin Nonresidential Use <br /> Type of Construction a - Residential Use S r I -. <br /> Occupancy Group i'lte--- Proposed No.of Dwelling Units: <br /> Occupancy Load <Vie— ,// Total No.of Dwelling Units: _ <br /> Fire Sprinklers: ❑Update Existing El New System LLI Not 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 El New System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: . Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ['Yeses ,'d No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑�Yeess A No Additional Notes: <br /> VALUATION CALCULATION: Total$ )CC ' <br /> Approved By: C. U.S Date: ' S/I 0/242-1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: EPW Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By: Date:,Si/Z 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 El 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 ❑ 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 <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> �2/7 <br />