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0 gz�og-o� <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1 <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 0 OK to Route to Other Departments <br /> B g I ddn/Rem Size Z7D ,S' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size A'>'4 Zone 'b/" <br /> Number of Stories I Overlay/Agreement <br /> Basement tiallo ❑Yes, Fin/Unfin Nonresidential Use et)Ca/?4€41-gt <br /> Type of Construction Residential Use <br /> Occupancy Group /S Proposed No.of Dwelling Units: <br /> Occupancy Load 2gr Total No.of Dwelling Units: <br /> Fire Sprinkle/CI Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes taiNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: P3Update Existing El New System ❑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 M No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes ,lo Additional Notes: <br /> VALUATION CALCULATION: Total$ zoo/ OOO,CD <br /> Approved By: K-` (13Date: q: ,Z <br /> UBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By � Date' '❑Backflow Prevention for high hazard: <br /> ���� i(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 uiOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Not s: AI El This Permit is Approved by Public Works <br /> —fY \.' ' c' ,,, ❑ 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 ❑ Is in a Separate Green Folder aoin with this folder for permit issuance) <br /> RReview/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:V4,, M Date: CI.-j 1 2( )74--ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: d ed/�8 1-4.-tr <br /> Approved By: Date: Approved By: Date: <br />