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Intake &Approval Sheet *OR PERMIT STAFF ONLY) 4 PERMIT# " _ <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 0 OK to Route to Other Departments <br /> Bldg/TI/Ad Rem Sid 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size A/a Zone <br /> Number of Stories Z- Overlay/Agreement <br /> Basement 'Elko ❑Yes, Fin I Unfin Nonresidential Use . <br /> Type of Construction - //6 Residential Use <br /> Occupancy Group 4 Z Proposed No.of Dwelling Units: <br /> Occupancy Load A/)T i°//a✓t;p�� Total No.of Dwelling Units: <br /> Fire Sprinklers:FtUpdate Existing ❑New System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: rii pdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'l RCW 64.55 does required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$/:S °da, 60 ( ) <br /> , , - %U -- J — 2c72 <br /> Approved By: C i n i-exio('11/ Date: Ill 1/20 is <br /> PUBLIC INO M,' <br /> . Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if. .,•••.•••„•,•W. <br /> 10Sys Dev Eval ❑TrafficMit Eval <br /> ❑Site Work or Drainage Proposed. <br /> Approved By. Date: / �-� ❑Backflow Prevention for high hazard: <br /> `�/ =(dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT 0 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 El Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ., <br /> ❑This Permit is Approved by Public Works C <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 0 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:,#4 ,02,m4-) Date: /�,2o21—. 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 />