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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# ZI D y—nap <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 /> ❑ 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 iL 1 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use ry Si-g, <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes)PNo <br /> Reason Sprinklers Required: "In Lieu"Fee: Type: Amount$ <br /> Fire Alarm: El Update Existing El New System El 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 ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add]RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: Coo v3-- dF ei.47 C — <br /> VALUATION CALCULATION: Total$ C — pjci'S =—c`5 o/— <br /> ' <br /> a5 d- ;7 �' a�l" <br /> Approved By: K- Cl <br /> Date: �. ZI <br /> UBLIC WORKS " <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: tPW Worksheet Needed if: <br /> Ct O(�lij IT N'L4d JcP OSys Dev Eval OTraffic Mit Eval <br /> J / (r` €DSite Work or Drainage Proposed <br /> Approved By:---)_ r Date:Ct- '2_0-" OBackflow Prevention for high hazard: <br /> 3 �`� ((dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT El 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 /> El Fire Sprinklers El Fire Alarm El 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: 0 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(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: .Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL �( , , %� <br /> Additional Notes: t" 0 � ,„� (4J <br /> Approved By: Date: Approved By: Date: 1 / 70 I t <br />