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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# 2-1 03—Oo5 <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. <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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone VAL) <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No /❑Yes , Fin/Unfin Nonresidential Use e(V, <br /> Type of Construction / Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: mar�yv'' <br /> Fire Sprinklers: El Update E i ting ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? Ekes I sJo <br /> Reason Sprinklers Req ' ed: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑ date Existing El New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire A m Required: Calculated: Credit: <br /> RCW 64.5 F worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ `C GCCI <br /> Approved By: ( Date: i-V 6‘ 7.4 <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 1 ❑Site Work or Drainage Proposed <br /> Approved By: Date: i�// /10 '❑Backflow 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/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El 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 coin 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 />