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• <br /> • ! 1 —c -5 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLI9 PERMIT# 1 <br /> BUILDING PLANNING <br /> Intake OK by: 12 QV—` Date: V/572,0"2-3 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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addnem Size) ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone V';0 <br /> Number of Stories 2- Overlay/Agreement <br /> Basement i ]No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction L e Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load . fie Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System 'lot Req'd Planning/Landscape Inspection Required before Final? ❑Yeslo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$. <br /> Fire Alarm: ❑Update Existing ❑New System EtNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ppt�1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 'LJNo Additional Notes: 'i"'k,.rn Lt�c..- CY) -i (\O C,,frw 'i-t; <br /> VALUATION CALCULATION: Total $ /t ,E)& 0 .e, b/ l ty _- re,J` o I u l <br /> 66 <br /> Approved By: 1L. Date: to,Zl <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: ci..,L,(1 _T Intake Comments: !PW Worksheet Needed if: <br /> ljZ&A/ ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: , Date: 3//c�2z, €❑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 /> ❑Fire Sprinklers ❑Fire Alarm ❑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 /> ❑ 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 />