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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 62\o4 O3 <br /> BUILDING ' ,PLANNING' <br /> Intake OK by: Date: Intake OK by Assign To:1'W4 Date:44/24//-124 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ R ute to Historic Reviewer <br /> El Make this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Add i/Rem Size / j�!� ct ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No r(YeCF)/Unfin Nonresidential Use <br /> Type of Construction [/ Residential Use 5 � <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 ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System LJNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: �e� Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes NJ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes 121No Additional Notes: <br /> VALUATION CALCULATION: Total$ jt1` cot <br /> Approved By: GO Date: tie/242A <br /> PUBLIC WORKS.. <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> /472/0,21 <br /> ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: �� � Date:j :(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: DThis project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <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 ❑ 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: El Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: ‘-t Date: 11- 4.b /•Z�, <br /> 3 <br />