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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# &A L O ~ l OLf <br /> BUILDING • PLANNING • . ' .•. - . <br /> • <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/Addn/Rem Size 0 Hold in Planning File Drawer + ' <br /> Garage/Accessory Struct.Size Zone (lid <br /> l'v <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 /> Fire Sprinklers: El Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New Systemot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.56 MF worksheet req'd for permit? ❑Yes 0 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$25 04Ve DO <br /> Approved By: 4 Date: f ji /2.02Z <br /> PUBLIC WORKS <br /> Intake OK by: 'ro Date: 8 ism 1-24 I-I-- ..................w,,,,,,,,,.. <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if. <br /> R.10 ?u.t S"e ❑Sys Dev Eval ❑Traffic'Mit Eval <br /> IOSite Work or Drainage Proposed <br /> Approved By. d Date: y'Z i C'Backflow Prevention for high hazard: <br /> / (dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: r �(03 ❑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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> ❑ Review/In ection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By ' }-fpi <br /> Date:Oef/�6 L Z -ublic Works has no scope---PW Not Required <br /> / Additional Notes: <br /> ELECTRICAL p <br /> Additional Notes: g/I 2 4 I�ZZ <br /> Approved By: Date: Approved By: Date: 6s <br />