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Intake &Approval Sheet i (FOR PERMIT STAFF ONLY) * PERMIT# S Z l(0 o03 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by Assign To C.c. Date:(d(cl <br /> Intake Comments: Intake Comments: <br /> CO(i c—FWon t4.kru4v0-- V/14?I ` <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size $15K <br /> ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone (iI a_ <br /> Number of Stories Overlay/Agreement ,Sr CO*, <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction - Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load • Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing CI New System CI 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 El Everett School Dist ❑Mukilteo School Dist <br /> Add'l RCW 64.55 dots required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ /S,3/I. ?8 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> IDSys Dev Eval OTrafficMit Eval <br /> A:,,,. b,/,c/ z IDSite Work or Drainage Proposed <br /> Approved B : Date:A//�/ IDBackflow Prevention for high hazard: <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 /> El Fire Sprinklers ❑Fire Alarm El Other: AND ❑Create Green Folder ❑Submitted Previously ODeferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑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 ,tr ern've Leevt, 94,,4- 10(Z(Z <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B . Date: [2_1- 1 ,02_,,1,. <br /> z7 <br />