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Intake &Approval Sheet 410 (FOR PERMIT STAFF ONLY) • PERMIT# Iv�� b2.. 06 I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building El ttach to Project No. <br /> ❑ Route to Residential Building 4 ❑ Route to Historic Reviewer <br /> ❑ Make this a" " it t ❑ OK to Route to Other Departments <br /> Bldg/TI/Add em Size f. ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories ' Overlay/Agreement <br /> Basement UNo ■Yes, Fin/Unfin Nonresidential Use _ <br /> Type of Construction V—t3 Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 14/ Total No.of Dwelling Units: <br /> Fire Sprinklers: ElU•sate Existing CI New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklo Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: gfUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason r re Alarm Required: Calculated: Credit: <br /> RCW %,.55 MF worksheet req'd for permit? ❑Yes 0'No ❑Everett School Dist ❑Mukilteo School Dist <br /> Ad.I RCW 64.55 docs required prior to final? ❑Yes Cho Additional Notes: <br /> VALUATION CALCULATION: Total$ / pZOa <br /> Approved By: " Date: /�7/ 2/ <br /> PUBLIC WORKS «! <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> IDSys Dev Eval OTraffic Mit Eval <br /> J DSite Work or Drainage Proposed <br /> �8' r /Approved By: Date /6z71 i0Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute 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 ❑Deferred <br /> Additional Notes: CI 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 />