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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 14 04 oLict <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK byJ,_ Assign To: Date: y/,j 122• <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 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Oyes, Fin/Unfin Nonresidential Use ,�,�Q�,, <br /> Type of Construction Residential Use <br /> ul�i F J <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: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: t�vv Calculated: Credit: <br /> II <br /> RCW 64.55 MF worksheet req'd for permit? tcvYes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total$ FR)056 <br /> I,tPQL �Ylr � q( 2i!/Z7_ <br /> Approved By: Date: <br /> A�� t '/' PUBLIC WORKS <br /> read 2Gu (o'4.% tuor1161/ i7. Intake OK by: . Date: <br /> Additional Notes: AkE Rac�F Pe'4tMt - Intake Comments: _PW Worksheet Needed if. <br /> IUSys Dev Eval ETraffic Mit Eval <br /> =DSite Work or Drainage Proposed <br /> OBackflow Prevention for high hazard: <br /> Approved By: Date: ,e`/,2!J/ f • _(dental,medical,animals,mortuary,hospital, <br /> ( _supportive housing) <br /> FIRE DEPARTMENT DRoute 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❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 /> 0 Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> 0 Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 Review 1 Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />