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• • 2 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#V `\-0 J-1— <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> • <br /> Basement ❑No ❑Y.s , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Unit <br /> Occupancy Load Total No.of Dwelling Units, ' <br /> Fire Sprinklers: El Update Exist',. El New System El Not Req'd Planning/Landscape I pection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Require,.. "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Upd a Existing El New System ONot Req'd School Impact F-,-: Total $ <br /> Reason Fire Alarm equired: Calculated: Credit: <br /> RCW 64.55 MF w sheet req'd for permit? ❑Yes ❑ No ❑Everett "chool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64. docs required prior to final? Ekes ❑No Addition. Noted: <br /> VALUATIO CALCULATION: Total$ <br /> Approved By: J.(_ k)1,A_ Date: t1,--1 0 - Z j 2( <br /> L` WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> cr` �7,.� ❑Backflow Prevention for high hazard: <br /> Approved By I�v ��'��rly� :(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> PARTMENT 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 ❑Fire Alarm ❑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 associa attached items <br /> Fire Dept. Fees: i ❑ A Separate PW Permit is Requir-s- =ermit#: PW ) <br /> ❑ Review of As-Bu. Plans-NO FIRE FEE AND ❑ Is located in this fol.-, <br /> ❑ Minimal or No, ire Scope-NO FIRE FEE ❑ Is in a Separate,. 'teen Folder(join with this folder for permit issuance) <br /> ❑ Review/In ,ection Scope-ADD FIRE FEE ❑ Will be issu-• separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved B ,: Date: ❑ Public Works h.. no scope---PW Not Required <br /> j Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved L Dat-: (,C mil©-2_62( <br />