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• 0 <br /> 11 t ô <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# l 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permi El OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Siz <� r�� ❑ Hold in Planning File Drawer <br /> - f AA— NM <br /> Garage/Accessory Struct. Size .�, �-�/7 .� Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement ®No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction VL3 Residential Use <br /> Occupancy Group 6{ Proposed No. of Dwelling Units: <br /> Occupancy Load 6 Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required f6re Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: mount$ <br /> p q <br /> Fire Alarm: ID 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 Dis ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes INo Additional Notes. <br /> VALUATION CALCULATION: Total$ s)a:%L'.JG <br /> Approved By: Date: t^\, Z S._ 'Lo'0t <br /> PUBLIC WORKS <br /> Intake OK by: tr Date: 0 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> �b) 7- DSite Work or Drainage Proposed <br /> ,) /,� /t v ❑Backflow Prevention for high hazard: <br /> Approved By( �; J t✓f'! Date: ( �.,4/-; Le/ �_ (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: 0 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(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: 3 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: ` <br /> V <br /> 2 4` <br />