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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#\ 0-0 `4(S <br /> BUILDING PLANNING <br /> Intake OK by: Date: 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 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 24-( ❑ 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 V- S Residential Use <br /> Occupancy Group _ u Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ®Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type:_ Amount$ <br /> Fire Alarm: El Update Existing ❑New System El 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 Sch I Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes J No Additional tes: <br /> VALUATION CALCULATION: Total$ 11°4' <br /> Approved ��,� Date: \0. \q, LO2., <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: IR.Evl eW Fait. LIT I ''r`/ Intake Comments: PW Worksheet Needed if: <br /> -T-vk-GI,t <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: j -Q/ Date: 1 2.40 �.1.t,z,( ❑Backflow Prevention for high hazard: <br /> (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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND�. ❑Create Green Folder ❑Submitted Previously El Deferred <br /> Additional Notes: D 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 2.db 2.- 02.8 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ti 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 ❑ 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: 7 ,i7 <br />