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Intake &Approval Sheet (FOR PERMIT STAFF ONLI PERMIT#_ C <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> ake Comments: Intake Comments: Assign To: <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 2,5 03 to ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size u5G( I* Zone (i <br /> Number of Stories 2 Overlay/Agreement c) <br /> Basement ®No ❑Yes , Fin/Unfin Nonresidential Use �— <br /> Type of Construction Residential Use G � <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 Mo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ akly <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 /> IAdd'I RCW 64.55 dots required prior to final? ❑Yes ❑No Additional Notes:—� <br /> VALUATION CALCULATION: Total $ rJ <br /> Approved By: Date: 1D <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> •----------------------------------------- <br /> Additional Notes: Intake Comments: ;PWWorksheet Needed if. <br /> • <br /> ❑Sys Dev Eva] ❑Traffic Mit Eva[ <br /> ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: Date: I (dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> :----------------------------------------- <br /> FIRE DEPARTMENT El Route this folder for PW Review at end --PW Review iorksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer--Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team ®This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 19 See PW Review worksheet and associated attached items <br /> Fire Sprinklers: El Update Existing El New System ❑ Not Req'd NfA Separate PW Permit is Required (Permit#: PW tq <br /> Fire Alarm: ❑Update Existing El New System ❑ Not Req'd AND 9 Is located in this folder <br /> Chemical Sup: El Update Existing ❑New System ❑ Not Req'd ❑ Is in a Separate Green Folder Goin with this folder for permit issuance) <br /> Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> -iproved By: Date: ❑ Public Works has no scope--PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: Q Zi , r <br /> Z Z <br />