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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# z-` I2 OF1 <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <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 ,j•tp 2,p 41," ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement 6/3No ❑Yes, Fin/Unfin Nonresidential Use t�� <br /> Type of Construction V tic Residential Use <br /> Occupancy Group - Proposed No.of Dwelling Units: <br /> Occupancy Load , 1 S Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System 21Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes to <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ISZ1Update Existing El New System El Not Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: VI Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑ I�`Yes 1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes INo Additional Notes: <br /> VALUATION CALCULATION: Total$ u <br /> Approved By: )L, Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: =PWWorksheet Needed if: <br /> IDSys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: J Date: 1�/,2 .2 10Backflow Prevention for high hazard: <br /> e.ypi1 :(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> • <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 /> 1�►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 /> la Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K,\%; (Ain Date:12, s�,/ ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By:Ak Date: 011 2S/2°27 <br />