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• <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# ` ' o'iA <br /> BUILDING PLANNING <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 /> taId i'I/Addn/Rem Size SZ, O ,SF ElHold in Planning File Drawer <br /> rage/Accessory Struct. Size it 7/?0 SF Zone <br /> Number of Stories C Overlay/Agreement <br /> Basement ❑No EYes, Fin/Unfin Nonresidential Use <br /> Type of Construction „�,Q Residential Use <br /> Occupancy Group 5Z 1 Proposed No.of Dwelling Units: <br /> Occupancy Load S 8 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: r "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing'i��ii 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? MYes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ,Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ y 6 7 44 <br /> sitea -The <br /> ( 4`D Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: jPW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By( ., Date: /r /V zb,q <br /> (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 <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 ail cal-o55 ( Yev.1-" 0 s-s.-c. <br /> Additional Notes: <br /> Approved By: Date: Approved By:'�� %� Date: /f/j /l q <br />