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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <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 0 OK to Route to Other Departments <br /> Bldg/TI Add em Size /w ,,off 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size /✓/,4 Zone 12,?_— <br /> Number of Stories / Overlay/Agreement <br /> Basement pNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use ,J 5F12_ <br /> Occupancy Group As- 3 Proposed No. of Dwelling Units: <br /> Occupancy Load At/74 Total No. of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ❑New System pNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes t'No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System lEINot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 12 No ❑Everett School Dist ❑Mukilteo S ool Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ENo Additional Notes: <br /> VALUATION CALCULATION: Total $ t1 ti 0 <br /> / <br /> Approved By: /j/,a\j,.j` Date: II -It.'to <br /> /'.'° PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: i <br /> i PW Worksheet Needed' <br /> ❑Sys Dev Eval 2 Traffic Mit Eval <br /> ❑Site Work• Drainage Proposed <br /> Approved B� Date.a./ '❑Back Prevention for high hazard: <br /> �\.7 Yam" t �/G ;(den- medical,animals,mortuary,hospital, <br /> is sportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Revi-• at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Requir:•: ❑This project also has a s-.arate concurrent PW Review(Green Folder) <br /> O Fire Sprinklers ❑Fire Alarm Other: AND ❑Create Green F.der ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is A•'roved by Public Works <br /> ❑ See PW Re '-w Worksheet and associated attached items <br /> 0 \ f <br /> Fire Dept. Fees: ' ElA Separ. e PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-B . Plans-NO FIRE FEE AND ■ s located in this folder <br /> ❑ Minimal or N. ire Scope-NO FIRE FEE A Is in a Separate Green Folder Qoin with this folderfor permit issuance) <br /> ❑ Review/I. pection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved S y: Date: • Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL itaN <br /> Add" ional Notes: <br /> A proved By: Date: Approved By: Date: <br /> /2_ <br />