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Intake &Approval Sheet 'FOR PERMIT STAFF ONLY) • PERMIT# SIa 0Cf_005 <br /> BUILDING PLANNING' 62 .O -p`ZO( <br /> Intake OK by: Date: Intake OK by(T `"1 P/Assign To: Date: i5/J?l_ <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 0 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 . lOr 'C.t"✓/ vV((L <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 ❑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: ❑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? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: <br /> VALUATION CALCULATION: Total$ // VS-40b <br /> "-j (111acakiP q 1 1617__Q <br /> Approved By: Date: <br /> PUBLIC WORFCS-. <br /> Intake OK by: 'g Date: I►3120 LL <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> wa'� glkbin 69191,0tAt Clq 11 !( Sys Dev Eval DTraffic'Mit Eval <br /> r hA JUt ❑Site Work or Drainage Proposed. <br /> Approved By: )y2�� Date:dot/y/Z�Z J Daackflow Prevention for high hazard: <br /> J / i(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> - . FIRE DEPARTMENT DRoute 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 DOther: 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 0 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 0 Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: EI Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By. AN Date: ft 11, \TOW <br />