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Intake &Approval Sheet •(FOR PERMIT STAFF ONLY) • PERMIT#b Zc ` �J� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> 0 Route to Commercial Building 0 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 —' CI Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ` Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement JNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction c"ree Residential Use <br /> Occupancy Group U Proposed No. of Dwelling Units: <br /> Occupancy Load 1 Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System DNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ONew System ftklot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes IM1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> AdenRCW 64.55 docs required prior to final? ❑Yes DNo Additional Notes: <br /> VALUATION <br /> �CALCULATION: Total $ dO/OZ <br /> ) <br /> X [�6 q/0 Approved By: (,, Date: j• ) / q /�L j I <br /> !— PUBLIC WORKS <br /> 7-I 0 <br /> l Intake OK by: Date: <br /> Additional Notes: Intake Comments: 'PW Worksheet Needed if: <br /> OSys Dev Eval OTraffic Mit Eval <br /> eil <br /> l <br /> • • OSite Work or Drainage Proposed <br /> Approved By: wf Date: OBackflow 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 /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review (Green Folder) <br /> ❑Route to Fire Drawer--- Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously 0Deferred <br /> ❑Sending Fire Notes to Project Team CiThis Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DUpdate Existing ❑New System ❑ Not Req'd ❑A Separate PW Permit is Required(Permit#: PW <br /> Fire Alarm: Update Existing ❑New System 0 Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd E❑--ryry Is in a Separate Green Folder (join with this folder for permit issuance) <br /> Additional Notes: El Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: � l ' -f Date: c , 'IG i t L` c <br />