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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �2-2-01—0,15- <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building �1v <br /> � ��..//� El 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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement NNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction VAResidential Use <br /> Occupancy Group W Proposed No.of Dwelling Units: <br /> Occupancy Load it Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing El New system 6QNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: []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 ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ bo 6M. / <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: �-----------" ------- <br /> =,PW Worksheet Needed if., <br /> =[]Sys Dev Evai OTraffic Mit Eva <br /> []Site Work or Drainage Proposed <br /> Approved By; pate; r[]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 /> --�- <br /> Separate/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 /> eTSee 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 /> ELECTRICAL Additional Notes: <br /> 'T SII-L-o23 A'--*Q-%Avv IGSu7 <br /> Additional Notes: <br /> Approved By: Date: Approved By:7-v Date: c,21,o 7 (-2o Z-r— <br />