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40 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT#-l0\O9'r O\, <br /> BUILDING PLANNING <br /> Intake OK by: AtVti Date: Intake OK by: Assign To: Date: <br /> Intake Comment-: Intake Comments: <br /> Vs-CUTE I • ,(Gr-r <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> 0 Route to Residential Building .Route to Historic Reviewer 120 v"._ --e,yt.)G..T'4 <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments ' C f fp v-,--ot_._ r <br /> Bldg/TI/Addn r?Size ....P. ❑ Hold in Planning File Drawer to`1f"/1 I <br /> Garage/Accessory Struct.Size ,� Zone —�, _ ll <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction ` Residential Use ' '' <br /> Occupancy Group 4, Proposed No.of Dwelling Units: J <br /> Occupancy Load Total No.of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing CI New System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes gl*No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ I <br /> Reason Fire Alarm Required: t� Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ray.No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EtNo Additional Notes: <br /> VALUATION CALCULATION: Total$ S <br /> Approved By: 0 � Date: '/z.7/c <br /> PUBLIC WORKS ( t <br /> Intake OK by:I Date: q //2? rl <br /> Additional Notes: -z0is— `� Intake Comments: jPW Worksheet Needed if: <br /> PrL-t— r6.4'TA.41-• Vite— IElSys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> e.lo 'Pw S(.o-T,'e t <br /> A roved By: Date: �f I.CIBackflow Prevention for high hazard: <br /> diApp l�/�7/�, ;(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 /> Cl 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: riffPublic Works has no scope---PW Not Required <br /> Additional Notes: p 42 7/ {ct <br /> ELECTRICAL <br /> Additional Notes: , <br /> Approved By: Date: Approved By: Date: <br /> l <br />