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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# � 2. C7)9 ro( <br /> 4---- <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 0 Route to Historic Reviewer <br /> ❑ Make this a "W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer j <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement .0 No ❑Yes , Fin/Unfin Nonresidential Use / <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Unjt's: <br /> Occupancy Load Total No. of Dwelling Unity. <br /> Fire Sprinklers: DUpdate Existing ❑New System El Not Req'd Planning/Landscape I pection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ONew 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 ❑Everett Sch of Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional N es: <br /> VALUATION CALCULATION: Total $ \Sbd:7 <br /> Approved By: � �� Date: G Q� .t2 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: sic-S.s -o FliE.tvA)-1 TOIntake Comments: iPWWorksheetNeededif:• <br /> oRi Gt.(6--Icy` L4/4 r-Crk(-b\r\a V4 t:G �'P�Ftq&ZS El Sys Dev Eval ❑Traffic Mit Eval <br /> 'S'P'Rc t£ ; i❑Site Work or Drainage Proposed <br /> Approved By: 4,T:„ Date: �Z ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT' El Route this folder for PW Review at <br /> 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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:Y.,,\c0u) \ Date: 'I 'Pi I ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: ) Approved By: Date: <br /> L/C� <br />