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110 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# " `a <br /> � A `k-t CO2.-- <br /> BUILDING ik W- ,, _ PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a "W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories _ Overlay/Agreement <br /> Basement El No ❑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 Existing El 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: El Update Existing ❑New System CI 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 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add)RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ <br /> Approved By: Date: <br /> .. .. PUBLIC WQ , ,,.,..".<.\4ii1: •. <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: - W Worksheet Needed if: <br /> ❑Sys Dev Eval Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: =❑Backflow Prevention for high hazard: <br /> =(dental,medical,animals,mortuary,hospital, <br /> _supportive housing) <br /> IE 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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred <br /> Additional Notes: 0 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(Join with this folder for permit issuance) <br /> Review/Inspection ope-ADD FIRE FEE 0 Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: /� '7vj Date: /I/i' /7 0 Public Works has no scope PW Not Required <br /> Additional Notes: <br /> p <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> :i/ <br /> ✓ <br />