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Intake &Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# 17� W Z104'00 j <br /> --o <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 El Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement No PYes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: -- <br /> Occupancy Load L Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes EANo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: []Update Existing El New System 116t Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 19 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes o Additional Notes: <br /> VALUATION CALCULATION: Total$ ( OJ D <br /> (i XU r/Q G r /�O&—, / Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: ,PW Worksheet Needed if.• <br /> a[]Sys Dev Eval ❑Traffic Mit Eval <br /> / ![]Site Work or Drainage Proposed <br /> i <br /> Approved By: -vim Date: ❑Backfiow Prevention for—high--hazard: <br /> J A(dental,medical,animals;mortuary,hospital, <br /> f ,supportive housing) <br /> t..-_._.__. <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: ❑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�dilt Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimalor No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder Qoin 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: blic Works has no scope—PW Not Required <br /> A ditional Notes: <br /> ELECTRICAL 1-411 <br /> Additional Notes: Pvi <br /> Approved By: Date: Approved By: Date: <br /> 4-7 <br />