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• <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# g 2/02-6T y <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 /> ❑ Road-to-Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> BidONddn/Rem Size RiAtek 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories l Overlay/Agreement <br /> Basement ❑No EYes, 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: ❑Update Existing ❑New System of Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System Tot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes a No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes -'lo Additional Notes: <br /> VALUATION CALCULATION: Total$4-00°. <br /> f <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> =OSys Dev Eval ❑Traffic Mit Eval <br /> =GSite Work or Drainage Proposed <br /> Approved B Date:ekeh.f � 3❑Backflow Prevention for high hazard: <br /> i(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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ODeferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 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 /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2 <br />