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0 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#V..) 2«O —021P <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 O El Route to Historic Reviewer <br /> ❑ Make this ' "Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Add Rem ' e is r ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,v/Z1 Zone lj j <br /> Number of Stories / Overlay/Agreement <br /> Basement IIINo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction egec. Residential Use -414AV ') U1 i <br /> Occupancy Group Proposed No.of Dwelling Units: J <br /> Occupancy Load Total No.of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ANo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New SysterAl Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: / <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo Schoyfist <br /> Add'I RCW 64.55 docs required prior to final? El <br /> o Additional Notes: <br /> VALUATION CALCULATION: Total $ Ci5i-d°O.00 <br /> Approved By: }/J., \ Date: 2 ) , Z'Z <br /> f BLIC WORKS <br /> 7s <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 /> Date: �/j0« ❑Backflow Prevention for high hazard: <br /> Approved By( � <br /> /' ;(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 /> OFire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 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: Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> /G 6-Sit <br /> I/7...e z 2 Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />