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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#'21 b`*#.bto V <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 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 1VA 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /4 AA Zone <br /> Number of Stories n 4 Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction >/ Residential Use <br /> Occupancy Group fl )c Proposed No.of Dwelling Units: <br /> Occupancy Load j4/A Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System IiNot Req'd Planning/Landscape Insp- ion Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System 11A 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 I2P No ❑Everett S ccl Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? "�❑Yes bNo Additional otes: <br /> (VALUATION CALCULATION: Total$ O ' <br /> Approved 8, � Date: o ttr - <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 57- 04 SA Ind €❑Sys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> I❑Backflow Prevention for high hazard: <br /> Approved By: ,�j�3f Date: �ir�a� (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: OThis 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: ❑ 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 /> ta 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: o9-1/31o`z� 1aPublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: / Date: c//3/p21_ <br />