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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#\3 20V''1 -o2-1‘ <br /> BUILDING PLANNING <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" Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <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: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection :-quired before Final? ❑Yes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing DNew System ❑Not Req'd School Impact Fee: Te al $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> ROW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett Scho. Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Nees: <br /> VALUATION CALCULATION: Total $ S0 <br /> Approved B Date: , �� LC)10 <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: j7 Date: ifjl 0� ElBackflow Prevention for high hazard: <br /> C`" ` 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 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 /> ❑ 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: Date: Ct Public Works has no scope PW Not Required <br /> Additional Notes: lit <br /> ELECTRICAL ��U <br /> Additional Notes: (Intl <br /> Approved By: Date: Approved By: Date: tr1tliA)10 <br />