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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) S PERMIT# (.?2)` <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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Access.♦ Struct. Size Zone -'L <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Ekes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 1vA(.1\\\--\ <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑Ne System El 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 ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? EiYes o ❑Everett School Dist Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Ekes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ &w k <br /> Approved By Date: \�, <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> \- \s'� ❑Sys Dev Eval Traffic Mit Eval <br /> 1��11 ❑Site Work or Drainage Proposed <br /> Approved By:l.�i % eniu� Z/gtZ '❑Backflow Prevention for high hazard: <br /> pp Date: (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute 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 El 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 /> gl 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:U L' C'IINO Date:'Z/ `4 P.Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: /r"1; Date: I,t IA, 2,0 <br />