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Intake &Approval Sheet (FOR PERMIT STAFF ON09 PERMIT#_ ?/V -6 <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 ❑ Route to Historic Reviewer <br /> ❑ Make this a 2E Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Ad Aem Stze ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 1 1:�5 Zone ` <br /> Number of Stories _k� 7_ Overlay/Agreement <br /> Basement ®No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction C Residential Use u I <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: \ <br /> Fire Sprinklers: ❑Update Existing ❑New System aot 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 System BNot 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 School Dist ❑Mukilteo School Dist <br /> Add1 RCW 64.55 docs required prior to final?l, ❑Yes Rlo Additional Notes: <br /> VALUATION CALCULATION: Total $ `/C 7Cli QJ <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW worksheet Needed if. <br /> OSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> d j�. ❑Backflow Prevention for high hazard: <br /> Approved B Date:/ / u �_ € <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 El Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> RSee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: � Separate PW Permit is Required(Permit#: PWZZnS-0Zo <br /> E ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND f s 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/PLUMBING <br /> Additional Notes: <br /> Approved By: Date: Approved Bye j Date: 75L4.LZ <br />