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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# "B2\2 D1 <br /> BUILDING PLANNING <br /> Intake OK b Date:l f�9J�z�� Intake OK by: Assign To:_ Date: <br /> Intake Co ts. 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 5 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use (yat Gool, <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: CI Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IgfNo <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: g Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Dyes No Additional Notes: ex�� /2,1.,,,) i ` \ <br /> VALUATION CALCULATION: Total$ cte, c 0 ?OA 4..,4 <br /> �-�(re <br /> Approved By: Date: q.Zq,4 <br /> UBLIC WORKS <br /> Intake OK by: , Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> -OSys Dev Eval ❑Traffic Mit Eval <br /> -OSite Work or Drainage Proposed <br /> Approved By: Date: ��/ 2� <br /> Back ow Prevention for high hazard: <br /> { ❑=(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: ❑ 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 /> ige.eview/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:1<,PjIfe. tyn Date: 0;,6,; 1 14 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL Aw �S i i9 /LO L'Additional Notes: 7 v <br /> Approved By: Date: Approved By: Date: <br />