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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#M Z20(o-- 07 T <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK bey Assign To: Date:IP/30M <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone Pi-- <br /> Number of Stories Overlay/Agreement <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use r <br /> Type of Construction Residential Use (klirQ e.... <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ItNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System ElNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes 1 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes isNo Additional Notes: <br /> VALUATION CALCULATION: Total$270 0GO,00 <br /> _fid1.444 Ve0/7--? - <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date:©Nret,`L— ❑Backflow Prevention for high hazard: <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 /> El Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ODeferred <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 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 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 By: Date: <br />