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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 2/0 6 —69 6 <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 AI/4 Zone 6 <br /> Number of Stories j Overlay/Agreement <br /> Basement ON/o ❑Yes, Fin/Unfin Nonresidential Use <br /> IV <br /> Type of Construction •Q Residential Use <br /> Occupancy Group 5 Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System eNot 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,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 01 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IN No Additional Notes: <br /> VALUATION CALCULATION: Total$ TZ Zq/_$0 <br /> Approved By: M, -" <br /> t 1i § Date: ( i <br /> � PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: DPW Worksheet Needed if. <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved B Date:&//7� i)]Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I 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: Cl 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 /> YSMinimai or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(loin 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:14,'Q]cown Date: 02' Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By:'1 Date: I (Q/ 20 2 <br />