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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by:7 Date: 34 Pt_ Bed Intake OK by: 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/Tl/Addn/Rem Size 3-? ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories I Overlay/Agreement <br /> Basement grNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction V`'.] Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Lod PI- Total No.of Dwelling Units: <br /> Fire Sprinklers: Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: Z, X "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: laUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: t Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes at No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 'r2No Additional Notes: <br /> VALUATION CALCULATION: Total$ �7 y OCT <br /> / eu) Approved By: 'f. L Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 61 e,, I b (t CO ❑Site Work or Drain- 'roposed <br /> Approved By: -�r Datte: t — ❑Backflow Pr- -ntion for high hazard: <br /> (dental,me..,-,animals,mortuary,hospital, <br /> support' -housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review a •nd --PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separ. concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Fold- •Submitted Previously ❑Deferred <br /> Additional Notes: ❑This Permit is Appr.,ed by Public Works <br /> ❑ See PW Review orksheet and associated attached items <br /> Fire Dept. Fees: ❑A Separate P Permit is Required (Permit#: PW <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is .cated in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ s in a Separate Green Folder(loin 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: ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />