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0 0 Qrz <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 8 Z i 0 5-6 4% <br /> BUILDING PLANNING <br /> ``Q� / <br /> Intake OK by: Date: Intake OK by Assign To:TrY�I� • Date: (/ . I•2-02'1 <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 ,'OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ro/,Q, •7I( ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone V2„ <br /> Number of Stories / Overlay/Agreement <br /> Basement 'u,Irr No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction -4-12 Residential Use <br /> Occupancy Group Z-'2 C 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 CI No <br /> Reason Sprinklers Required: " "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System-MMot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes JNo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ Gd049• �/0 <br /> Approved By: V 3 Date: (o. I,.2-62-i <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By. 3 <br /> Date: Q/�j'2/ 1❑Backflow Prevention for high hazard: <br /> (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 ❑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: 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 /> O 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: 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 /> EL-6...,_ <br />