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• <br /> • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2_003""�2 <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 /> O Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> sY <br /> Bld TI/Ad n/Rem Size 7G0 , 7 ❑ Hold in Planning File Drawer <br /> a a//Accesso ruct. Size '(' 2 /f Zone <br /> Number of Stories Z Overlay/Agreement <br /> Basement l''No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use JAI' <br /> Occupancy Group ,Q--,j Proposed No. of Dwelling Units: <br /> Occupancy Load /0 Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing El New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 'lo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing New System allot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 51 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 12No Additional Notes: aS /_,\ o'' <br /> VALUATION CALCULATION: Total $-Sam � <br /> Approved By: 44,1 11,4 Date: 11 .5, )O7 o <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PWWorksheetNeededif. <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> l❑Site Work or Drainage Proposed <br /> Approved B 1 L1 Date:/p/(177ez l =❑Backflow Prevention for high hazard: <br /> l� :(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 /> DFire Sprinklers El 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 /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: D-Public Works has no scope---PW Not Required <br /> Additional Note • s <br /> ELECTRICAL <br /> 71I6I-z - <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />