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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# Ec9 2v(9 <br /> BUILDING .• PLANNING <br /> Intake OK by: Date: Intake OK b f.%-�/m- Assign To: Date: II /72i _ <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 UT-- <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction • Residential Use ry)V 1-1-1 m I <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 ONo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate 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? RYes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Ekes ANo Additional Notes: <br /> VALUATION CALCULATION: Total$ 65 7`o. .‘1 <br /> 'Cb1/111-kt- 11716tA)" / <br /> Approved By: Date: <br /> PUBLIC WORKS'- <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if. <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved �r? Date:id/d i/z02,7_, ;❑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 /> El Fire Sprinklers OFire Alarm DOther: AND ❑Create Green Folder OSubmitted 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: 0 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 0 Is in a Separate Green Folder(loin 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 />