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1110 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONL19 PERMIT# Q <br /> Z(0 -O Z / <br /> BUILDING ��(� PLANNING <br /> Intake OK by: Date: Intake OK by:j /g Assign To: ,i r/V . Date (3/?-QL 1 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ R ute to Historic Reviewer <br /> El 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 ❑Ye Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use SFie— <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existi New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Reason Sprinklers Require . "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Upd Existing ❑New System Mot Req'd School Impact Fee: Total $ <br /> Reason Fire Alar equired: Calculated: Credit: <br /> RCW 64.55 MF orksheet req'd for permit? DYes ❑ No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? DYes ❑No Additional Notes: <br /> / <br /> VALUATION CALCULATION: Total$ 4, el L 7 <br /> Approved By: Ag Date: (S J2O2.i <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if:� —_ <br /> iDsys Dev Eval OTraffic Mit Eval <br /> IDSite Work or Drainage Proposed <br /> / /'7 ❑Backflow Prevention for high hazard: <br /> Approved By: !✓ Date: • _(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 OCreate 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 />