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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) . PERMIT# D� 0 51 <br /> BUILDING / PLANNING <br /> • <br /> Intake OK by: V n'y-ff Date: � l g 1'L�i Intake OK by: Assign To: Date: <br /> Intake Comments: 1111 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 0 OK to Route to Other Departments <br /> BIdg/TI/Addn/4em Size 43 ft ❑ 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 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 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 15/DOCK <br /> Approved By: Date: !1! (t°/045° <br /> _ PUBLIC WORKS <br /> Intake OK by: . Date: /. 2 LZl/ <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if: <br /> I Sys Dev Eval Traffic Mit Eval <br /> 57 =DSite Work or Drainage Proposed <br /> Approved By: � Date: 3 f litZ,Z -❑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 I 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: 0 This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 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: Public Works has no scope---PW Not Required <br /> A ditional Notes: <br /> ELECTRICAL <br /> Additional Notes: 001 I2\Z2'.2-- <br /> Approved By: Date: Approved By: Date: <br /> Z 2 <br />