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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) ail PERMIT# -).-10 •-O °I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK b 2 Assign To: Date: 3 • �`..-4— <br /> Intake Comments: Intake Corn <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 3-j 3 3 It ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size .... Zone /v\V` <br /> Number of Stories S redCov,f4alfficgreefnecit/SIN-T Q,\ r teC r <br /> Basement INo DYes , Fin/Unfin Nonresidential Use o <br /> Type of Construction / c1&. Residential Use <br /> Occupancy Group 1 Proposed No.of Dwelling Units: <br /> Occupancy Load t,t./ Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System SNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes -No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: IldUpdate Existing El 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? ❑Yes INo ❑Everett School Dist ❑Muki School Dist _ <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ' No Additional Notes: <br /> VALUATION CALCULATION: Total$ f 7J)O'C'cl <br /> Approved B Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> 3 <br /> j❑Sys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> Approved By: z.AglaDate: 7 l„71 I❑Backflow Prevention for high hazard: <br /> i(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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works a <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 /> IffReview/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:\.gibtA) - Date:3.30,2/ ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> /2?...— ,_ <br />