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• • /� <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#S2o OD( <br /> BUILDING PLANNING' <br /> Intake OK by: Date: Intake OK by: 0145 Assign To: 1"1 tO4 Date:2/2,72 J <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> O Make this a"W" Permit bK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone likA <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use 1 t <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 DNew System ❑Not Req'd Manning/Landscape Inspection Required before final? ❑Yes <br /> Reason Sprinklers Required: "In Lieu Type: mount$ <br /> Fire Alarm: El Update Existing ❑New System ONot Req'd School Impact FeeTIbtal$ <br /> Reason Fire Alarm Required: Calculated: Cr ' . <br /> RCW 64.55 MF worksheet req'd for permit? DYes ❑ No ❑Everett S Dist ❑Mukilteo School Dist <br /> `Adel RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: /2„.../2_0 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> I❑Sys Dev Eval OTraffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> Approved By: Date: loth ❑Backflow Prevention for high hazard: <br /> j(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 ❑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 /> ❑ 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: <br /> Approved By: Date: Approved By: Date: <br /> 2/Y <br />