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►ntake & Approval Sheet (FOR PERMIT STAFF ONLY) II PERMIT# $ZI 06- 0 6 0 <br /> BUILDING PLANNING <br /> Intake OK by; Date: eP/Z--(3/zez/ Intake OK by Assign To:T i4)4 6 . Date:(G•2q,i2aq <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ '.ute to Historic Reviewer <br /> ❑ Make this a"W"Permit ►1 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone LL+•Z <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <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? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? pp❑Yes El No Additional Notes: NI ex-freer user werK carrot/44 <br /> VALUATION CALCULATION: Total$/d) If,D 47 V*t-t-14Ls perm*. No chatty ;n crpoye <br /> Approved By: vg. Date: CIL� jZ,l <br /> PUBLIC WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 30Sys Dev Eval ❑Traffic Mit Eval <br /> (]Site Work or Drainage Proposed <br /> ;DBackflow Prevention for high hazard: <br /> Approved Date:07/737d71 <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 El Submitted Previously ODeferred <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 /> D 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:K cerx,vn Date: ���/ ❑ Public Works has no scope---PW Not Required <br /> 3 2/ Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: / <br />