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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <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" mit 0 OK to Route to Other Departments <br /> Bldg/TI/AdSize ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /dt) Zone IF�Z <br /> Number of Stories / Overlay/Agreement <br /> Basement ❑No IEIYes, Fin/Unfin Nonresidential Use <br /> Type of Construction "e_C Residential Use 5W <br /> Occupancy Group =�G Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ,Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 1Y3No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amo <br /> Fire Alarm: ❑Update Existing ❑New System IEJNot Req'd School Impact Fee: Total $ • <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes In No ❑Everett School Dist ukilteo School Dist <br /> Add I RCW 64.55 docs required prior to final? Yes 12INo Additional Notes: <br /> VALUATION CALCULATION: Total$ 7,-°0 <br /> Approved By: r. Date: ' 'vi <br /> • UBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> IDSys Dev Eval OTraffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> Approved Date;lj� =OBackflow Prevention for high hazard: <br /> �J'' i(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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> fa 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: ,/ <br /> Approved By: Date: Approved By: 4 1 Q ` Date: 62 /3o/)c Z/ <br />