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! . 2�� <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#r6 2 -025 <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 /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone (..-Z <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No f/Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 6C-t2 <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: 0 .date Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑ s` Jo <br /> Reason Sprin. -rs Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Mary. ❑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 Di <br /> Add'I RCW 64.55 does required prior to final? ❑))Yes El No Additional Notes: i;'o c 1.,� coti, .o.�ns> S�C,b�1i' <br /> VALUATION CALCULATION: Total $ /f! Ct � ��"', <br /> Approved By: \i,,\! Date: 7,7..- <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PWWorksheet Needed if: <br /> s❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: �! <br /> jjc� ❑Backflow Prevention for high hazard: <br /> �� <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 /> ❑Fire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ 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 /> ❑ 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: ta,Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: \ Date: 1.1 7,1 IV <br /> ,i <br />