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0 •Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# . 21 I l— 6�� <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 0 '.ute to Historic Reviewer <br /> ❑ M-•- this a"W"Permit i a to Route to Other Departments <br /> BI•.• ddn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone (/t,iZ3 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential User <br /> Occupancy Group 4 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 o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New 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 '51 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? Dyes - No Additional Notes: <br /> VALUATION CALCULATION: Total$/7Ot ,bb <br /> Approved By C. Date: ( t . (Z . 2 <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> = Sys Dev Eval ❑Traffic Mit Eval <br /> ; Site Work or Drainage Proposed <br /> Approved Bllll��////����,. Date:erz ,/4O Zi iOBackflow 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 /> El 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: k s‘Q1 j Date: 1\-1F_2,,, a Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: U.l'12 bS92.\ <br />