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- EZlo4--IIS <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# S Z L ©zt -CO <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 'NJ <br /> A) <br /> Number of Stories Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use --ez <br /> Type of Construction Residential Use ✓J <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before inal? ❑Yes o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing CI New System ❑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 ❑ No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: y.„1 Date: q-7.71-7.4 <br /> PUBLIC WORKS' <br /> Intake OK by: Date: 4 127 12 r <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> IDSys Dev Eval ❑Traffic Mit Eval <br /> `DSite Work or Drainage Proposed <br /> Approved By: Date: I❑Backflow Prevention for high hazard: <br /> I(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for P.W 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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder OSubmitted Previously El 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 separat Folder,PW issued ahead of Bldg) <br /> Approved By: Date: IZIPublic Works has no sco e - PW Not Required . <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: ,r <br /> Approved By: Date: Approved By: ---Zy Date: al ZI/2,1 <br /> 21v <br />