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ebZ�07 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# _7'% 0L1 <br /> BUILDING PLANNING — O Q <br /> Intake OK by: Date: Intake OK b Assign To: Date: 2 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑Yake this a"W"Permit ❑ OK to Route to Other Departments <br /> BI /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 Gj'%-- <br /> Type of Construction Residential Use <br /> Occupancy Group r — Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: M,1pdate Existing ❑New System 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 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add1 RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ .Pco oC <br /> JApproved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes:C1,6C 1�'i`1rfrrr.4�' Intake Comments: PW Worksheer Needed if.- «Y <br /> ❑Sys Dev Eval []Traffic Mif Eval <br /> �� (V E❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved B . \ Date: 6 /Oi L !(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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND El Create Green Folder []Submitted Previously ❑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 Coin 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: ❑ Public Works has no scope-- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL/PLUMBING <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />