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• <br /> ' 1t--f <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# 1()d b3 ( <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 /> Basement ONo ❑Yes, Fin/Unfin Nonresidential Use fit'_ A <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: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final?-Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type:__ A nt$ <br /> Fire Alarm: DUpdate Existing ❑New System ONot 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 DEverett School Dist ukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total SSW 0v,ov <br /> Approved 51? Date: 5' LT'.202Q <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: �~ <br /> 3DSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved 13... Date:69w 7�� ❑Backflow Prevention for high hazard: <br /> / Vdental,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 OFire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ['Deferred <br /> Additional Notes: El This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: g A Separate PW Permit is Required(Permit#: PW U O(0-0`Z,t-f` ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> El Minimal or No Fire Scope-NO FIRE FEE ❑ 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:Y. 9cistAN1 Date: 5 - 92Q,,p ❑ Public Works has no scope--- PW Not Required <br /> Addit'o al Notes: <br /> ELECTRICAL 1 l 1 . <br /> Additional Notes: <br /> Approved By: Date: Approved By:11(4 Date: 10 lip fiT <br />