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Intake & Approval Sheet • (FOR PERMIT STAFF ONL1) • PERMIT# oat 0-0 1,0. <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 _ ElOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone FAA 0 <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 El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yeslo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El 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 ❑ No ❑Everett School Dist ❑Mukilteo School ist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: AVes0.-P-e-a , ` elf— <br /> VALUATION CALCULATION: Total$ .10(� I 1_0 r ' — <br /> Approved By: Pk Date: Ill <br /> T�,�u7 <br /> PUBLIC WORKS'' <br /> Intake OK by: Date: <br /> Intake Comments: PW Worksheet Needed if: <br /> Additional Notes: 14o , e'Vy WM1sA&AC Pit.0903ST, <br /> N o 8ut.,o%%Ai REY/t5W REL2`D ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ftemc.,e. vN1.t{, Y4/ i El Site Work or Drainage Proposed <br /> Approved By: Date: ❑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: ❑This Permit is Approved by Public Works <br /> 0 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: Os Public Works has no scope---PW Not Required <br /> Additional Notes: ,e4-QC C viL <br /> ELECTRICAL O�(5+(v q i1a-u-okG 1- 5ty, <br /> Additional Notes: J <br /> Approved By: Date: Approved By: CZ)s— Date: t( / i '2 10 <br /> t 2/2— <br />