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Intake &Approval Sheet 410 (FOR PERMIT STAFF ONLY) • PERMIT# m tl'0- ©�� <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 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use. <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ONew System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes I(No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ❑New System ONot 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 docs required prior to final? ❑Yes ❑No Additional Not s: .t1J-Q_,,J \c,,GQ\. l.A4 59.\\ Yr\ <br /> VALUATION CALCULATION: Total$ az qN �W \&Q'k ` \0 A'A CS' <br /> Approved By:( Date: Ok, `%. \C.\ <br /> PUBLIC WORKS <br /> Intake OK by: „AI 4- Date: Cligi Z®/g <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: N/'bIlJ <br /> ei: • o 6 t"- i❑Sys Dev Eval ❑Traffic Mit Eval <br /> i❑Site Work or Drainage Proposed <br /> Approved By: !IP Date: �p =❑Backflow Prevention for high hazard: <br /> 1 I07 Ii(dental,medical,animals,mortuary,hospital, <br /> isupportive 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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND El 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(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ElWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> yy <br /> Approved By: Date: .IE(Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: f <br /> Approved By: Date: Approved By: JKC/.-1 Date: �/ie/zen <br /> 2J <br />