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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# FD e)(32._ <br /> BUILDING PLANNING' <br /> Intake OK b Date: Intake OK b C1/ZCL <br /> y: y: `,� Assign To:��.��� Date:�/� <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit "OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size S_7/ Q' ? 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone _.12. <br /> Number of Stories I Overlay/Agreement <br /> Basement _❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction //l—f3 Residential Use <br /> Occupancy Group 5,,5-/�.(/ Proposed No. of Dwelling Units: <br /> Occupancy Load //,- Total No. of Dwelling Units: <br /> Fire Sprinklers:'Update Existing ❑New System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: [Kpdate 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 riNo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add]RCW 64.55 docs required prior to final? ❑YYes No Additional Notes:.% re_ at,�,��� 174/ <br /> VALUATION CALCULATION: Total $ ifc G) OCO" <br /> Approved By: a. Date:4. /4-2aJ1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: �j l� Intake Comments: PW Worksheet Needed if: <br /> /L e'_ G! /4$ ❑Sys Dev Eval OTraffic Mit Eval <br /> / J ❑Site Work or Drainage Proposed <br /> Approved By: / �S Date � ElBackflow Prevention for high hazard: <br /> Lst //// j '(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 /> Erfire Sprinklers ire 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 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Er Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:(�j�x,"n Date:.' , jam/ , ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> /e-/-- <br />