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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# B22y5'^a3� <br /> BUILDING PLANNING <br /> Intake OK by: Rafe; 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 FHold <br /> oute to Historic,Reviewer <br /> Make this a"W"Permit K to Route to Other Departments <br /> Bldg/T[/Addn/Rem Size in Planning File Drawer <br /> Garage/Accessory Struct. S€ze Zone <br /> Number of Stories Over]ay/Agreement <br /> Basement []No ❑Yes, Fin/Unfin Nonresidential Use . <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No,of Dwelling Units: <br /> Fire Sprinkler Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sp ' klers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alar : El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> ReasgK Fire Alarm Required: Calculated: Credit: <br /> RC 64"55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Muki[teo School Dist <br /> dd'l RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> Approved By: 6A5 Date: (10 <br /> PUBLIC W6RK8 ` <br /> Intake OK by: Date: <br /> Additional Notes: �! Intake Comments: DPW Worksheet Needed if. <br /> Q OL ��C OVL-Y 1OSys Dev Eval ❑Traff€c'M[t Eva[ <br /> 1l ``,E]Site Work or Drainage Proposed <br /> Approved By: — Date: �e✓� E�Backflow Prevention for high hazard: <br /> t(denial,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT El Route this folder for PW Review at end ---PWReview 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 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#: 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 ihts 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: Appraved By: Date: <br />