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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) � PERMIT# �(S©r-OOo <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> BldgiTl/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 Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ❑New 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 DEverett School Dist ❑Mukilteo School Dist. <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 14. D(YR-- <br /> ) not TWVA/ Y\eibApproved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Mi Date: J2h1(Z4z <br /> Additional Notes: Intake Comments: PWWorksetNeededif:• <br /> /f tAl J� ej(Jq %' OSys Dev Eval ❑Traffic Mit Eval <br /> i t�►� J ❑Site Work or Drainage Proposed <br /> Approved By: �_ Date: 1 re, ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT Route this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 'This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DUpdate Existing IgNew System 0 Not Req'd 0 A Separate PW Permit is Required(Permit#: PW ) <br /> Fire Alarm: DUpdate Existing ONew System ❑ Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: DUpdate Existing ❑New System ❑ Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: r (DK ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By kokj,.'` - Date: e Z?-1 B 0 Public Works has no scope---PW Not Required <br /> 11, <br /> Additional Notes: �,�,e <br /> ELECTRICAL ..C\ 1` � — C\\,4`�� c� T l ". <br /> Additional Notes: <br /> Approved By: Date: Approved By: _SF) Date: CtI , VA'S <br /> CO <br />