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2l °ia <br /> Intake &Approval Sheet (FOR •PERMIT STAFF ONLY} • S <br /> PERMIT# �'L{obq—bdgLf b <br /> BUILDING : PLANNING' • <br /> Intake OK by: Date: Intake OK by: _ Assign ToVl/d Date: a <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ '•ute 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 4Y1 LI <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: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Req red before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update 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 ❑Everett School Dist ■Mukilteo School Dist <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total$ //6 S'U DD <br /> Approved Date: \Q . tC:r <br /> PUBLIC WORKS" <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if.• <br /> 10Sys Dev Eval ❑Traffic Mit Eval <br /> • <br /> • =DSite Work or Drainage Proposed• <br /> Approved By i Date: iD/z.�t/Zd7"/ �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 /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑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 /> ❑ 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 /> ZJa <br />