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• • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# $21 1 1 bg 1 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ake this a"W"Permit 'OK to Route to Other Departments <br /> B /TI/Ad n/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone IA/2 3 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use " <br /> Type of Construction Residential Use Mt' <br /> Occupancy Group 12--Z Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑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 ❑l No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? Oyes fwNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 4'x der6Nj <br /> Approved By Date: / 1 . /Z. Z/ <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if: <br /> ;OSys Dev Eval ❑Traffic Mit Eval <br /> IOSite Work or Drainage Proposed <br /> ;OBackflow Prevention for high hazard: <br /> Approved B h7 Date: 11-1/42A r =(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: ❑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:V...,NC70 ( 4-NDate: `\-. \(37 -9.\ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: _ <br /> Approved By: Date: Approved By: ....111)) Date: 11 fa.,)2011 <br />