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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) ' PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by P Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 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/Accessory Struct. Si_e Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ■ o ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use Jv\s \ <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New Syste ❑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 • s.t Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: it: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ . ❑Everett School Dist ❑ kilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ b�K <br /> Approved By: � � Date: \` , <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: if:Intake Comments: PW Worksheet Needed <br /> 3\OACS ❑Sys Dev Eval OTraffic Mit Eval <br /> OSite Work or Drainage Proposed <br /> Approved By: l.C/ CitO Date:'2/S/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/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers El 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 /> 12 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: (.ii� C-00 Date: tiO I Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: ,, Date: 9\ ,I j 2/ 2,0 <br />