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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> 52-101 — ©13 <br /> BUILDING PLANNING <br /> Intake OK by: Date: ( 202_I Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> \p, �,\find <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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: CI Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection -quired before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: •tal $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No DEverett S- ool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes CI No Addition. Notes: <br /> VALUATION CALCULATION: Total$ CD`J" / ODO <br /> Approved i y!"---- Date:`�—l j . <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: `Tatdbc le.i.fs"F'RVVKRort APTAI041.41 Intake Comments: PW Worksheet Needed if: <br /> r-out.)i aTta,4 `* A,tJG dt ;OSys Dev Eval ❑Traffic Mit Eval <br /> OSite Work or Drainage Proposed <br /> Approved By: Date:' ((t7 OBackflow Prevention for high hazard: <br /> • :(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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AN N[y❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 6/his 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(loin 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: n Date:40 " 7 21 CI Public Works has no scope PW Not Required <br /> v _ W Additional Notes: <br /> ELECTRICAL <br /> Additional Notes:Approved By: Date: Approved By: Date: /& 4oz <br />