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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1022 bZ� <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 12.31 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size - Zone <br /> Number of Stories :L Overlay/Agreement <br /> Basement R3No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction V • b Residential Use <br /> Occupancy Group Im Proposed No.of Dwelling Units: <br /> Occupancy Load Zt Total No.of Dwelling Units: <br /> Fire Sprinklers: Update Existing El 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 ❑New System El 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 ❑Muki[teo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ Z50t:7 non-� � � ate► <br /> Approved By: _ Date: `.lj.�_L7— <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Intake Comments: I PW Worksheef Needed if.~-� <br /> Additional Notes: , <br /> 3 <br /> 0Sys Dev Eva] ❑Traffic Mit Eval <br /> sl]Site Work or Drainage Proposed <br /> Approved By: Date: .� , _ I]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�M�� <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: 4his 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 /> R-`Nlinimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor 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: _ (�- 2 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B . Date: <br /> �i � 2'F°Zo'YL <br /> 2 <br />