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• • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ?21o3 —0-0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: 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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 5-c, 4 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone LZZ <br /> Number of Stories rr��ii (7 ‘Aci Overlay/Agreement <br /> Basement t[3INo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction (f — Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load f3 l Total No.of Dwelling Units: <br /> Fire Sprinklers: Update Existing Mew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes PtClo <br /> Reason Sprinkler'Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: 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'I RCW 64.55 docs required prior to final? J❑Yes M No Additional Notes: <br /> 0-b ,ACAet <br /> VALUATION CALCULATION: Total$/j� r�� CI f�` �l/l� <br /> Approved By: it., I Date: 3,4.24 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: / ❑Backflow Prevention for high hazard: <br /> lJ `(dental,medical,animals,mortuary,hospital, <br /> 'supportive housing) <br /> FIRE DEPARTMENT 0 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 0 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: YNiczNA)\0 Date: 3 172/ ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 212_ <br />