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• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# es 1 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • Route to Commercial Building 0 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 "-}'9 ,¢-°' 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ^ Zone <br /> Number of Stories 'A. Overlay/Agreement <br /> Basement ZINo ❑Yes, Fin/Unfin Nonresidential Use . few,(ante <br /> Type of Construction \.[ Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 2$' Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System Ill Not Req'd Planning/Landscape Inspection Required before Final? Ekes tNo <br /> Reason Sprinklers Required: 4 (.R[ -frq-° "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System PrIl Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: 'e 3e:/e,0'C-+" Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? :Yes 1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑ 1Yes tINo Additional Notes: <br /> VALUATION CALCULATION: Total$ 4,GxPe) <br /> Approved By: ij_� Date: '6k("' <br /> �`" UBLIC WORKS <br /> Intake OK by: Date: <br /> Intake Comments:Additional Notes: 'PW Worksheet Needed if: <br /> i <br /> ❑Sys Dev Eval ❑Traffic Mit Eval , <br /> ❑Site Work or Drainage Proposed. <br /> Approved By: c- :,1, Date: ell �,p,2.r ❑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 l 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 /> 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 0 Is located in this folder <br /> El Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> rReview/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: -• L oO )fl Date: 9--9..2/ 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />