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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> r <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/T[/Addn/Rem Size Hold in Planning File Drawer <br /> Garage/Accessory Struct. S e Zone U <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin 1 Unfin Nonresidential Use . <br /> Type of Constructi Residential Use <br /> Occupancy Gro p Proposed No, of Dwelling Units: <br /> Occupancy L ad Total No.of Dwelling Units: <br /> Fire Sprin rs: ❑Update Existing ❑New System ❑Not Req'd Planning/Lattdscape Inspection Required before Final? ❑Yes ❑No <br /> Reason prinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire rm: ❑Update Existing ❑New System [hot Req'd School Impact Fee: Total $ <br /> Re on Fire Alarm Required: Calculated: Credit: <br /> VR 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> dd'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> Approved By: Date: Q Z LeZZ <br /> PuBLlc VIlbR)<8 <br /> Intake OK by: _Date: <br /> Additional Notes: Intake Comments: !PIN WorksheetNeeded If.,� <br /> �� IF-]Sys Dev Eva[ ElTraffic'Mit Eva[ <br /> OS[te Work or Drainage Proposed. <br /> ate: p IElBackf[ow Prevention for high hazard: <br /> Approved By: <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 1 Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND El Create Green Folder El 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 M 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 Wth this folderforpermit Issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW Issued ahead or 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 />