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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# a bl <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <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 iv/A ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size r Zone L,3.\ <br /> Number of Stories / 4,b-z,Z Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use \�q �t � 't o <br /> Type of Construction —'// Residential Use ��11 <br /> Occupancy Group F—1 Proposed No.of Dwelling Units: <br /> Occupancy Load Al/A- Total No.of Dwelling Units: .---' <br /> Fire Sprinklers: OSUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? Dyes INo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ❑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 ffiNo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes ZIo Additional Notes: <br /> VALUATION CALCULATION: Total$ 17 esl 0'40 <br /> Approved By: _ ) Date: u , •.2O2` <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: ...,...,. -((�`&0 y w- T'` n ► �`� <br /> �j' '` 'OSys Dev Eval ❑Traffic Mit Eval <br /> /� ❑Site k r anos <br /> Approved By: L Date:ai/ -/�f DO <br /> ackflWorow PreventionoDriage forPr highpo hazard:ed <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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <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 /> Igkeylew/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:L\.Fy(0(.4,, Date8—/7-2 I 'Fil,Public Works has no scope---PW Not Required <br /> dditional Notes: <br /> ELECTRICAL MO 5d4pi, W" ' /Additional Notes: <br /> Approved By: Date: Approved By: Date: 44. <br /> C`i 24 <br /> Zl <br />