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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# .R�2CA'0Y1 <br /> BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK b Assign To: Date: crp_o/ <br /> Intake Comments: • Intake Comme ts: <br /> • <br /> • <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑Make this " "Permit 0 OK to Route to Other Departments <br /> BldgfTl/ tip <br /> e ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct,Size Zone nit) <br /> Number of Stories Overlay/Agreement <br /> Basement 4,, ['Yes, Fin/Unfin Nonresidential Use ((/ <br /> Type of Construction I Residential Use <br /> Occupancy Group 103 Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers:Ef Update Existing El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ,jJpdate Existing Mew System Mot Req'd School Impact Fee: Total $ - <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$8Z/soo fo ' <br /> 7( a (/t Cl�t.Cif '�l (7�/ <br /> pproved By: Date: <br /> PUBLIC WORKS <br /> intake OK by: . Date: _ _ <br /> Additional Notes: Intake Comments: PW Worksheet Needed if:m.,,.—_—,.,..M„ <br /> =DSys Dev Eval ❑Traffic Mit Eval <br /> a <br /> IDSite Work or Drainage Proposed <br /> Approved By. Date O9 76'j�, �l]Backflow 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:Al° 6'/ ❑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 ❑ 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/I ection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By ( Date: (J`q �� 'ublic Works has no scope---PW Not Required <br /> 'dditional Notes: <br /> ELECTRICAL <br /> Additional Notes: oetliti2.012 <br /> Approved By: Date: Approved By: Date: <br /> z_ <br />