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Intake &Approval Sheet • (FOR PERMIT STAFF ONL • PERMIT# 160-m0-D21 <br /> BUILDING PLANNING <br /> • <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 ❑Yes, Fin/Unfin Nonresidential Use <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: El Update Existing El New System ❑Not Req'd Planning/Landscape Inspection Requi :d before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: A mount$ <br /> Fire Alarm: El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: P edit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist Mukilteo School Dist <br /> Add!!RCW 64.55 docs required prior to final? ❑Yes ❑No Addit'• . 'o es: <br /> VALUATION CALCULATION: Total$ <br /> Approve Date: <br /> 57 1°i. 1.5322 <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> DUB+ AC���e' �Q <br /> ~__...........--~--- <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> A roved By: Date: Plan AAM a 1 Q 11 (v '❑Backflow Prevention for high hazard: <br /> pP <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> - - W� <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 ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: IP This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items h 1a, <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 /> 0 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 �QVLOI� <br /> Additional Notes: �� T L 7 f Yv <br /> Approved By: Date: Approved By:. v0A0,11,1 Date: (14 I'?j2 <br />