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intake &Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT# OA—061 <br /> BUILDING PLANNING' <br /> Intake OK by: g _. Date: 1/( (2 0 Z 1 Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> % <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 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone (L . <br /> Number of Stories 2 Overlay/Agreement <br /> E Basement No Oyes, Fin/Unfin Nonresidential Use <br /> Type of Construction POvto 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 dlot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: ,,.�,,// "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System L"INot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: ,�,/ Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes L'7 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes le No Additional Notes: v1 O <br /> VALUATION CALCULATION: Total$ 3, S 0 D <br /> Approved By: V_,,, Date: 4, 71 <br /> BLIC WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: `PW Worksheet Needed if:DM© o F E1: �tZtoiL Rf � i <br /> STD 02-5 4 671 Yz.e S 'AAA wrrlt Mc--D j OSys Dev Eval QTraffic Mit Eval <br /> 1110-(%44 N F- rvr $Tft-t(t3 e iDSite Work or Drainage Proposed <br /> Approved By: �t6._ Date: q`I f 2cl( 10Backflow Prevention for high hazard: <br /> !(dental,medical,animals,mortuary,hospital, <br /> isupportive 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 /> ID Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: .; El 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 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />