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4111 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# G 2.D l2--00 <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 tier / .A) ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone ( .1 <br /> Number of Stories / Overlay/Agreement <br /> Basement lNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction 5 Residential Use 6414 , � <br /> Occupancy Group 3 Proposed No.of Dwelling Units: <br /> Occupancy Load I Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System lhot Req'd Planning/Landscape Inspection Required before Final?' ❑YesNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing Mew System Clot Req'd School Impact Fee: Total $ / <br /> Reason Fire Alarm Required: Calculated: Credit:? <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes i® No ❑Everett School Dist ❑Mukilteo S ooI Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: / <br /> VALUATION CALCULATION: Total$ 7.5 ;cc <br /> Approved By: ' I Date: 7r 2 y— to <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: Worksheet Needed if: <br /> f❑Sys Dev Eval OTraffic Mit Eval <br /> ID Site Work or Drainage Proposed <br /> l <br /> 'UBackflow Prevention for high hazard: <br /> Approved By: 4F` Date: 2A/71 <br /> (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 El Fire Alarm ❑Other: AND ❑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 /> Et-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: Vjrnt 7A Date: , '5 Z 21 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Prk Date: V 4 21 <br />