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III <br /> --al) <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT# Jd 17 <br /> BUILDING PLANNING ` <br /> Intake OK by: Date: Intake OK byi� 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 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size kgZ ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 1 Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement I2rr No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group 13 Proposed No. of Dwelling Units: <br /> Occupancy Load -1 €940' Total No.of Dwelling Units: <br /> Fire Sprinklers: OJpdate 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: laUpdate Existing El New System ONot 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.'RCW 64.55 docs required prior to final? ❑Yes C' No Additional Notes: <br /> VALUATION CALCULATION: Total$ L ?Jt2 <br /> Approved By: Date:g,/i/,31 <br /> PUBLICWORKS" <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> DSys Dev Eval OTraffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By: e= j Date: ,/�0 l]Backflow Prevention for high hazard: <br /> 3(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 /> 18fire Sprinklers .tt�TFire 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 Qoin 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:k, .n n Date: 12-I:2D,?ogeublic Works has no scope---PW Not Required <br /> Additional Note 14/2o-z-c> <br /> ELECTRICAL ( <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> �7/ <br />