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3)) 1 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONL)9 PERMIT#SkR(A <br /> BUILDING PLANNING <br /> Intake OK by Date: Z Intake OK by: , N-P- C 09 Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building �❑/Route to Historic Reviewer <br /> El Make this a"W" Permit L� OK to Route to Other Departments <br /> BldgfTI/Addn/Rem Size Z S g DO ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /✓/X Zone -2 <br /> Number of Stories / Overlay/Agreement <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use pecqc U <br /> Type of Construction Residential Use <br /> Occupancy Group j Z Proposed No. of Dwelling Units: <br /> Occupancy Load SZ Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System 5Not Req'd Planning/Landscape Inspection Required before Final? Eryes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System 11 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 J2 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 $ Z 700 060,CV <br /> Approved Date: Z <br /> PUBLIC WORKS <br /> Intake OK by: Date: Z Z <br /> --- ---------------------- <br /> Additional Notes: Intake Comments: ;PW worksheet Needed ik <br /> -S((�� ;❑Sys Dev Eval ❑Traffic Mit Eval <br /> e a— ;❑Site Work or Drainage Proposed <br /> Approved By• % �- Date: ���� b �r ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> '----------------------------------------- <br /> FIRE DEPARTMENT El 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 ❑Deferred <br /> Additional Notes: OfThis 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_ o3-' .o � <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ,•Minimal or No Fire Scope-NO FIRE FEE R 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: 1�AAIVJ Date: 07) ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved <br />