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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# R21.O5 O2 <br /> BUILDING jj�� PLANNING <br /> Intake OK by: Date: Intake OK by:615' Assign To: n P - Date:C/i 3/243 j <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 DK 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 ■ o ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use SIg• <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinkler-. Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: •Update Existing El New System El Not Req'd School Impact Fee: Total $ • <br /> Reason Fir: Alarm Required: Calculated: Credit: <br /> RCW 64. MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I r W 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> V UATION CALCULATION: Total$ J01J?® <br /> Approved By:06 Date:c/'3/- 4z. I <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: 1PWWorksheetNeededif:: <br /> !DDsBaYsckDeflovwEpvareiventElTrionfaoffr <br /> ic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By: j Date: lZ f/ high hazard: <br /> I(dental,medical,animals,mortuary,hospital, <br /> €supportive housing) <br /> FIRE DEPARTMENT DRoute 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder Goin 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> Z fz <br />