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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#Q'L1i6 G 6C0 0 <br /> BUILDING PLANNING <br /> Intake OK by: f—R 44 Date: a' 7-11--Z Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> Iff 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 1 V <br /> Number of Stories Overlay/Agreement <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction �C-- Residential Use 4ft+t 5 <br /> Occupancy Group Q—C_ Proposed No.of Dwelling Units: <br /> Occupancy Load 1(2—C—• Total No.of Dwelling Units: ' <br /> Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El 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? DYes ❑ No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: /' ( uplL� rtft5 <br /> VALUATION CALCULATION: Total$ TOe� '( Tiiqe �yv <br /> Approved By: '_ . ,? <br /> Date: ( Z <br /> BLIC WORKS <br /> Intake OK by: ^►`t Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 14til AA RS SOME CT riv ? S cot C- 1DSys Dev Eval ❑Traffic Mit Eval <br /> ft t SPE_ 1os3 ❑Site Work or Drainage Proposed <br /> i A T°� R ti Date: 7/� 7jZ ❑Backflow Prevention for high hazard: <br /> Approved By: <br /> ' �I / €(dental,medical,animals,mortuary,hospital, <br /> =supportive housing) <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: ❑ This Permit is Approved by Public Works <br /> 0 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 0 Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> ��..I <br /> Approved By: Date: l�Qublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: 6/z 6/t ,.z z <br /> Approved By: Date: Approved <br /> Date: <br /> 0-1Z <br />