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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# S 7-0`0(J <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK bc Assign To: Date: (472 <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 TeL46;1 (NJ)nti is-e)4I77u!c1) <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 El New System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? El Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ oOe) <br /> jk OPT n(lar6J (e1tZt, <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if. <br /> IOSysDev Eval ❑Traffic Mit Eval <br /> EOSite Work or Drainage Proposed <br /> OBackflow Prevention for high hazard: <br /> Approved By: Date: I S .. <br /> �/2. ��by (dental,medical,animals,mortuary,hospital, <br /> fff 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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ODeferred <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: Date: lPublic Works has no scope--- PW Not Required <br /> Additional Note ()AL i ;hi) "1"A.F6) <br /> ELECTRICAL/PLUMBING okti llx <br /> Additional Notes: ��� ov(2 20 22 11 Ol fzo z2. <br /> Approved By: Date: Approved By: Date: <br /> ZL <br />