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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# g72 e) �OOZ- <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 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> BldgITl/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone Uk <br /> (&_S <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Ekes, Fin/Unfin Nonresidential Use . A `.3 <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 [(Not Req'd Planning/Landscape Inspection Required before F' . es No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: mount$ <br /> Fire Alarm: El Update 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 ❑ No ❑Everett School st ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes ❑No Additional N s: <br /> VALUATION CALCULATION: Total <br /> Approved Date: '.IC)', <br /> PUBLIC WORKS'` <br /> • <br /> Intake OK by: Date: <br /> Additional Notes: Destt..1 c Lc�,4cxr��.�� r Intake Comments: PW Worksheet Needed if: <br /> 5'&e Ft'.F ❑Sys Dev Eval ❑TrafficMit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: & Date: S. ��Prs�Z ❑Backflow Prevention for high hazard: <br /> // Il (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 ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: J ❑This Permit is Approved by Public Works <br /> 0 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: <br /> ELECTRICAL 3(c 4 /20 2Z <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: �7 <br /> v <br />