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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# g 0,2--6)0-os3 <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 DYes, Fin/Unfin Nonresidential Use . <br /> Type of Construction VA Residential Use <br /> Occupancy Group ,e—Z Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System ONot 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 DMukilteo School Dist <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: ' f7q <br /> VALUATION CALCULATION: Total$% ` 7yyr1 s ✓` <br /> Approved By: )1,I Date: 1,73✓1J <br /> • <br /> UBLIG WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: Worksheet N.eeded if. <br /> (]Sys Dev Eval ❑Traffic Mit Eval <br /> • <br /> ❑Site Work or Drainage Proposed. <br /> Approved By ib Date:C9..e 2'z_ ❑Backflow Prevention for high hazard: <br /> _(dental,medical,animals,mortuary,hospital, <br /> isupporive 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 /> El 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />