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Intake &Approval Sheet 410 (FOR PERMIT STAFF ONLY) PERMIT#Y -000"0 . <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"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone tJ V <br /> Number of Stories Overlay/Agreement -TOO <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 Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ' No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ONew System ❑Not 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 /> Add'I ROW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: o Peieti �'N- <br /> VALUATION CALCULATION: Total$ � lOLn 5 <br /> Approved By: iG, Date: q. ZY. 2,0-4.0 <br /> P LIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: `PW Worksheet Needed if: <br /> i❑Sys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> Approved By: Date: /may,/j© l]Backflow Prevention for high hazard: <br /> c =(dental,medical,animals,mortuary,hospital, <br /> isupportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I 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: 1. ❑This Permit is Approved by Public Works <br /> ■ - '- Worksheet and associated attached items <br /> Fire Dept. Fees: 1A Separate PW P; mit is Required (Permit##: PW ON`''- 1)) <br /> ❑ Review of As-Built Plans-NO FIRE FEE • • ' • ated in this folder <br /> I Minimal or No Fire Scope-NO FIRE FEE 0 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: L Date: S-�1t i s n e <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: ,---7%27---: d9 2.49 <br /> Approv Date: Approved By: if`6 Date: ? <br /> /2 <br />