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Intake & Approval Sheet (FOR PERMIT STAFF ONL) PERMIT# 4D,'�AQ <br /> BUILDING PLANNINd- <br /> Intake OK by: Date: Intake OK by.DWI _ Assign To: Date: <br /> Intake Comments: Intake Comments: <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/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use . <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> U date EAstln ❑New System ❑Not Re 'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Fire Sprinklers: ❑ p g Y q <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update 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'I RCW 64.55 does required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ /6 1. OS <br /> 2 <br /> Approved By: Date: <br /> PUBLIC WbRK$' <br /> Intake OK by: D_ate:_____ <br /> Intake Comments: IPW Worksheet Needed if.• <br /> Additional Notes: I <br /> 10Sys Dev Eval ❑Traffic"Mit Eval <br /> IEISite Work or Drainage Proposed <br /> A roved B pate; ❑Backilow Prevention for high hazard: <br /> pp y �= ���� l�7 L. (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: ElThis 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 Qoln 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: EYPublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> - 3 - 1,�' <br /> Additional Notes <br /> Approved By: Date: Approved By: Date: <br />