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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# o3 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> D Route to Commercial Building D Attach to Project No. <br /> O Route to Residential Building O Route to Historic Reviewer <br /> O Make this a"W" Permit D OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 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: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ElUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes ❑ No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? DYes ❑No Additional Notes: & '`b W.A.— yam, r4t,,») L )wG'ty,-.n/fe[poS 1}t, <br /> VALUATION CALCULATION: Total $ {QA k1 or C-M2>,r '?3 j'1n3 fj \-• C-Z ' <br /> ctli <br /> Approved By: / /) Date: 1,74,ZL <br /> PUBLIC WORKS <br /> ��� Intake OK b <br /> Y: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> _7()� ,❑Sys Dev Eval (Traffic Mit Eval <br /> �s�y`' DSite Work or Drainage Proposed <br /> Approved By: Date: ❑Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> Isupportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end --- PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review (Green Folder) <br /> ❑Route to Fire Drawer--- Fire Preliminary Review Notice AND OCreate Green Folder [Submitted Previously ❑Deferred <br /> OSending Fire Notes to Project Team laThis Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) D See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ONew System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW <br /> Fire Alarm: ❑Update Existing ❑New System D Not Req'd AND ElIs located in this folder <br /> Chemical Sup: DUpdate Existing ❑New System D Not Req'd O Is in a Separate Green Folder (join with this folder for permit issuance) <br /> Additional Notes: 0 Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: D Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By , Date: <br /> �% /2.6'1Zc7�Ci <br />