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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <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 z <br /> C9S . S�✓I -�-1- El Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size - Zone <br /> Number of Stories ] Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction -+�" Residential Use <br /> Occupancy Group - �✓ - Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ®New System El 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 NNew 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 P9 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 $ <br /> 17-4 = �J d 3td- <br /> / t <br /> `7 I = ;Z l S�j Approved By: U PC ate: <br /> �5� x l Ce(o = lag 8cn� PUBLIC WORKS <br /> Intake OK by: Date: <br /> ........................._,.....__..........._.............................._.,............................ <br /> Additional Notes: Intake Comments: PW Worksheet Needed if. <br /> El Sys Dev Eva ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: ,'jam/ 1XV—) ❑Backflow Prevention for high hazard: <br /> ;(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT <br /> 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 /> IZZZ <br /> htffF�re Sprinklers -&ire Alarm El 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: ❑ 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 Qoinwith thisfolderfor permitissuance) <br /> Review/Inspection Scope-ADD FIRE FEE ❑ WIII be Issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ElPublic Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: `�{ ate: _'� <br />