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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 /> ❑ 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 19, SZ-o 4*�'- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone <br /> Number of Stories 4- Overlay/Agreement <br /> Basement ®No ❑Yes, Fin/Unfin Nonresidential Use . <br /> Type of Construction "A Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No,of Dwelling Units: <br /> Fire Sprinklers: IlUpdate 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: IM Update Existing ❑New 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 RCW 64.55 docs required prior to final? ❑Yes E]No Additional Notes: �huU nat- 'e&Ad b\ 1�-12 <br /> VALUATION CALCULATION: Total c ano ��n <br /> Approved By: Date: <br /> UBLIC UI/ORKs.' <br /> Intake OK by: _Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed If., <br /> ID Sys Dev Eval ElTraffic'Mit Eval <br /> '[]Site Work or Drainage Proposed <br /> Approved By: Date: �, ❑Backfiow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folderfor PW Review attend ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers .Ire Alarm ❑Other: AND El Create Green Folder []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 Z 2a 5 -a(V) <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 aoln urith this folder for permit Issuance) <br /> fTReview/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW Issued ahead of Bldg) <br /> Approved By: Date:2 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By. 461, <br /> Date: 9 1 p <br />