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• r <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#Z a� _opt <br /> BUILDING--,J / PLANNING <br /> Intake OK by: ( T Date: / 7 2.p�C Intake OK by: Assign To: Date: <br /> Intake Commeni : l ( Intake Comments: <br /> 0 Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> 0 Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ 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 Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units:r <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ONot Req'd Planning/Landscape Ins ection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type:-r 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 /> LtZ RCW 64.55 MF worksheet req'd for permit? DYes ��yy I No ❑Everett Sch of Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 1S=INo Additional Not s: <br /> VALUATION CALCULATION: Total $ Sqc, ono <br /> Approved By� '� Date: 559I 4-I Cit i <br /> �.e <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: ��— -r-E swag trc,�,.r�ogrt 0.1 Intake Comments: PW Worksheet Needed if: <br /> P" r-c a,JL 4, iDSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: '� Date: gl 141( <br /> 2t�4-t s❑Backflow Prevention for high hazard: <br /> '(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT DRoute 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 /> OFire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 /> 8.Minimal or No Fire Scope- NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 Review/ Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:<,AW n Date: 8'Z1i ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL A <br /> e Z 4"(24;$1r4 <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2 <br />