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j o <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ►'/ it L- L Il <br /> 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/TI/Addn/Rem Size . (7KU 6 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone ii\k.Q\ <br /> Number of Stories 7 't' 00,'" Overlay/Agreement _ <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use alrzet Aom-AAlc.. <br /> Type of Construction /—/A Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load I 9Total No.of Dwelling Units: <br /> Fire SprinklersUpdate Existing ❑New/System :Not Req'd Planning/Landscape Inspection Required befo - - nal? ❑Yes ❑No <br /> Reason Sprinklerss RRequired: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: IIUpdate Existing El 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? ❑ �,21 Yes No ❑Everett School Dist •Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final?{J❑Yes liNo Additional Notes: <br /> VALUATION CALCULATION: Total J ul a„I a <br /> Approved By --''fir Date: \. Q. Z..Q't t <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> =DSys Dev Eval ❑Traffic Mit Eval <br /> =OSite Work or Drainage Proposed <br /> Approved By: 1 Li(/ Date: lr0.9a9/ =❑Backflow Prevention for high hazard: <br /> _(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT El Route this folder for PW Review at end --PW Review Worksheet -�.....e. <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers El Fire Alarm El 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 /> l.Review/Inspection Scope-ADD FIRE FEE ; • Will be issued separately(Separate Green Folder,- :.ahead of Bldg) <br /> Approved By: ,b j(A,,n Date: 12:,Zg...., c I P'ubli' Works has no scope---PW Not Required <br /> •.. .nal Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />