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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> g 2Z© I — d54 <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 ❑ 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 <br /> Number of Stories Overlay/Agreement <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction — Residential Use <br /> Occupancy Group - 1. ) / Proposed No.of Dwellint nits: <br /> Occupancy Load Total No.of Dwelling .nits: <br /> Fire Sprinklers: ®Update Existing ❑New System ❑Not Req'd Planning/Landsc. .e Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinkler Required: "In Lieu"Fee:T .e: Amount$ <br /> Fire Alarm: EgUpdate Existing ❑New System ❑Not Req'd School Impa, Fee: Total $ <br /> Reason Fire Alarm Required: Calculate.. Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes II No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 12EINo Add'anal Notes: <br /> VALUATION CALCULATION: Total$ 6,46a0i 006 <br /> Approve Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: "Th.F,rc.ti Intake Comments: _PW Worksheet Needed if: <br /> =DSys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> OBackflow Prevention for high hazard: <br /> Approved By: j Date: 10 urn- _(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 /> .Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:\cij �i,\ Date:3--f ®'Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL / <br /> Additional Notes: ?% �// 3 tvt- <br /> Approved By: Date: Approved By: Date: <br />