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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK b Date: <br /> Intake Comments: Intake Comments: Assign To: tl <br /> ❑ Route.to Commercial Building Attach to Project No.l',V <br /> Route to Residential Building ❑l Route to Historic Reviewer <br /> Make this a"W" Permit 1%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 ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use S� <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: t <br /> Fire Sprinklers: []Update 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: [-]Update Existing El 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 0 No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes ISNo Additional Notes: <br /> VALUATION CALCULATION: Total $ 225, a ZZ <br /> (/-+2.4 49 tz l 1 72 1o1f <br /> J"6# Approved B Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: 61 YZ- 12o i 9 <br /> ----------------------------------------- <br /> Additional Notes: 070 IS 19c- kV sgc Intake Comments: ;PW Worksheet Needed if.• <br /> T — A ST�S►f3�o tt ;I�Sys Dery E al ❑Traffic Mit Eval <br /> T'-04,4IfSite Work or Drainage Proposed <br /> Approved By: Date: LJ 7,p — r}?4 is�,c• 2 t n 6 ${a 'OBackflow 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 El Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: I f A Separate PW Permit is Required (Permit M PW det_1C ?3 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 1�Is located in this folder <br /> ❑ Minimal or 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: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B Date: -7 ZG /R <br /> `I/ <br />