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5 21 O� r O1Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#BUILDING PLANNING <br /> • <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <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/Tl/Addn/Rem Size Apo; /l,4 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Agod Zone rZ <br /> Number of Stories I Overlay/Agreement <br /> Basement RINo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 5 <br /> Occupancy Group /e[ Proposed No.of Dwelling Units: <br /> Occupancy Load r/ Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing El New System ENotReq'd Planning/Landscape Inspection Required before Final? ❑Yes 9No <br /> Reason Sprinklers Required: mac, "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System CINot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 5 No ❑Everett School Dist ❑Mukilteo School D' <br /> Add'I RCW 64.55 does required prior to final? ❑Yes isiNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 7SvOv. OD <br /> Approved By: I(_e Date: e6, 6_ zA <br /> 1�� UBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: !:PW Worksheet Needed if: <br /> _DSys Dev Eval OTraffic Mit Eval <br /> IDSite Work or Drainage Proposed <br /> Approved By. Date:©d��ypL� ❑B3CkflOW 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 /> ❑ 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />