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I etake & Approval Sheet I (FOR PERMIT STAFF ONO. PERMIT 113 .&b\ O2(Q. <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 0 Route to Historic Reviewer <br /> 0 Make this a"W"Perm_it El OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 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 nits: <br /> Occupancy Load Total No. of Dwelling Wits: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscap: Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type. Amount$ <br /> Fire Alarm: ❑Update Existing Chew 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? Oyes ❑ No ❑Everett Sc ool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional N•tes: <br /> VALUATION CALCULATION: Total$ <br /> Approved Date:\\t.tCytZ, <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: �?�`� bF to Intake Comments: PWWorksheetNeededif: <br /> I❑Sys Dev Eval ❑Traffic Mit Eval <br /> IElSite Work or Drainage Proposed <br /> Approved By: Date: )4/ j I DBackflow Prevention for high hazard: <br /> f (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: ❑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: ❑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: Date: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: ' <br />