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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# '` 1C 1 ^c c L <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 El No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Unisi <br /> Occupancy Load Total No.of Dwelling Units <br /> Fire Sprinklers: El Update Existing ONew System ❑Not Req'd Planning/Landscape I spection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fe . Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No El Everett S ool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional otes: <br /> VALUATION CALCULATION: Total$ Sc'(-7 <br /> Approved By: Date: c.0 2 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 5?tire—es Intake Comments: iPWWorksheet Needed if: <br /> e'igtv L t.--JAt.- u 1�t cep tic ate} mp i❑Sys Dev Eval ❑Traffic Mit Eval <br /> Pq c�_ -Z�e�. I❑Site Work or Drainage Proposed <br /> J €❑Backflow Prevention for high hazard: <br /> Approved By: Date: 1 fi¢/ t (dental,medical,animals,mortuary,hospital, <br /> f :supportive 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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted 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 /> El-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: ,\�,('-0wN Date: G-1 q-2 ❑ Public Works has no scope PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> G�/ <br />