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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) 0 PERMIT# /14 ep,A,0 7 ♦ ( <br /> BUILDING . - . PLANNING • . • • 0 <br /> Intake OK by: Date: Intake OK b Assign To: Date:7l(�(!/ '• <br /> Intake Comments: Intake Comments: <br /> 0 <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 rn Li . <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use . ( C.C....,' <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 ONew 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: 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? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total$2900o DO <br /> T)3A/lAig n.i .141 `7f2Lof2 _ <br /> 1 oury ‘te\9fZ) -vep I rVit44J) Approved By: Date: <br /> VA/p/Y <br /> WlOOA - 0$A'f.L?/ .. PUBLIC WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: 1PW Worksheet Needed if: <br /> R A40�rn A =(_]Sys Dev Eval ❑Traffic Mit Eval <br /> ( F `"< t '2/O I OSite Work or Drainage Proposed. <br /> Approved E 9c y� Date: D1 Z 7_ ;❑Backflow Prevention for high hazard: <br /> �l ✓f _(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers OFire Alarm El Other: AND [(Create Green Folder CI Submitted Previously El Deferred <br /> Additional Notes: ; ❑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 0 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 0 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 <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: k <br />