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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1?)/--U- ) <br /> BUILDING ` PLANNINGIntake <br /> Intake OK by: s: Date: Intake OK by: ,`^4 Assign To: tCY. - Date: 3/1212'2d <br /> CoIntake Comments: <br /> t <br /> � <br /> ❑ Route to Commercial Building a G -0 ❑ Attach to Project No. <br /> ❑ Route to Residential Building rE. 0 Route to Historic Reviewer <br /> ❑ Make this a "W" Permit I (OK to Route to Other Departments <br /> (Bldggl/Addn/Rem Size o'Ze�-J"/ i //❑ 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 cif Residential Use -r�(/10 H -IVL.(L —t+I/U(,c- <br /> Occupancy Group `i-c Proposed No.of Dwelling Units: l <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System FiNot 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 Mot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: r�r Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes IJ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 'No Additional Notes: <br /> VALUATION CALCULATION: Total $ I ( I N ��� <br /> Approved By: (/ Date: 3/12 /20.2--( <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: / / Intake Comments: PW Worksheet Needed if: <br /> — <br /> J ✓/ ✓� r j fla A-(11 4, I =❑Sys Dev Eval OTraffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> Approved By: [ Date: //J%! ❑Backflow Prevention for high hazard: <br /> 3(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 OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ 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 ❑ 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 />