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• • PERMIT# �dZ'�JJ <br /> Intake & Ap <br /> proval Sheet (FOR PERMIT STAFF ONLY) l_.J� <br /> BUILDING PLANNING '. <br /> Intake OK by: Date: Intake OK by: (, Assign To:l l 1,1 Date: .2/ I fail <br /> Intake Comments: Intake Comments: 11 <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit taOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size / j 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone IAA <br /> ij <br /> Number of Stories / Overlay/Agreement <br /> Basement 121No ❑Yes, Fin/Unfin Nonresidential Use tiatit <br /> Type of Construction V — Residential Use <br /> Occupancy Group ES Proposed No. of Dwelling Units: <br /> Occupancy Load lc7) Total No. of Dwelling Units: <br /> Fire Sprinklers: oUpdate Existing ❑New System LJNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: '®Update Existing El 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? ❑Yes In No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'RCW 64.55 docs required prior to final? ❑Yes }E No Additional Notes: <br /> VALUATION CALCULATION: Total$ 7c ()CO' <br /> Approved By: at Date: 4,26. 2.02..1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: / - /0:7,1 =❑Backffow Prevention for high hazard: <br /> ;(dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT El 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 OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Li,Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: �'n Date: a j <br /> 3/3 <br />