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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 59 )N-a 0 i0( <br /> BUILDING . . . PLANNING E. 0 - 05/ <br /> Intake OK by: Date: Intake OK byTrn. Assign To: Date:-1 g1OZ..' <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone j <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use 0- CeY _ <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: ❑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 ONew 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 ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 dons required prior to final? ❑Yes ONo Additional Notes: <br /> VALUATION CALCULATION: Total$/a Dob 00 <br /> Approved By: Date: <br /> PUBLIC WORKS- <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> DSys Dev Eval ❑Trafic'Mit Eval <br /> • <br /> IOSite Work or Drainage Proposed• <br /> Approved B`y;\..,���+ Date: p,8/�ty�Z L.., ❑Backflow Prevention for high hazard: <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 /> ❑Fire Sprinklers ❑Fire 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 /> ❑ 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 /> Ad 'onal Notes: <br /> ELECTRICAL <br /> Additional Notes: aa <br /> Approved By: Date: Approved By: wilyv Date: D'U I lb 612/ <br /> U 2IZ <br />