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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) is PERMIT# ( 12-(0S 00 77 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK bA ___ Assign To X r. Date: )0'242-I_ <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size -,S. ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone �—2- <br /> Number of Stories "—' Overlay/Agreement _ <br /> Basement ❑No ' Yes , Fin/ nfin Nonresidential Use <br /> Type of Construction • rte Residential Use S - <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing El 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: ❑Update Existing El 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'I RCW 64.55 docs required prior to final? ❑Yes 112 No Additional Notes: <br /> VALUATION CALCULATION: Total$ nice). <br /> ��,r� <br /> Approved By: r(16 Date: , lO.20)-..1 <br /> PUBLIC WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> J ��l0f� I)]Sys Dev Eval Traffic Mit Eval <br /> �G C'! =OSite Work or Drainage Proposed <br /> Approved By: ej/f -- Date:/>/-/ l]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 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 /> ❑ 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 /> 4- <br />