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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# V'(1` 1 l `"l <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size _ Zone e--1 N' U 0 <br /> Number of Stories Overlay/Agreement t-qu 0 . <br /> Basement ONo DYes, 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: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes ONo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ❑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? DYes 0 No ❑Everett School Dist DMukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? DYes ONo Additional Notes: <br /> SGr�v`.z 3 2X1 S�nc <br /> VALUATION CALCULATION: Total$ Paro fet t 1;1C¢.- C-6r- 1;Ke reel a r\t- <br /> Approved By: y.... .\\,,,3 c Date: \\.--"Z„.&—)c( <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: (...\ Date: I (¢Cp)(lb ❑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 <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> DRoute to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously DDeferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DUpdate Existing ❑New system 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: DUpdate Existing ❑New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: DUpdate Existing 0 New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> ((' ) <br />