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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 111 I 16011 -d 12---' <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 /> 0 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 C— <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use CR-;- \ <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 kiNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: <br /> ----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 DEverett School lst ❑Mukilteo School Dist. <br /> Add'I RCW 64.55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ <br /> Approved Bye.---�- ----) Date: "T73 fj\V ` <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: Drew Date: q ❑Backflow Prevention • high hazard: <br /> dental medical nim- mortuary,hospital, <br /> ( ,a ry, P , <br /> supportive housin, <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end --- -W Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load --,New Commercial) ❑This project also has a separate con rent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fir- reliminary Review Notice AND ❑Create Green Folder ❑S..mitted Previously ❑Deferred <br /> ❑Sending Fire Notes t. 'roject Team 0 This Permit is Approved by 'ublic Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Wor eet and associated attached items <br /> Fire Sprinkle :. ■Update Existing ❑New System 0 Not Req'd 0 A Separate PW P- mit is Required (Permit#: PW ) <br /> Fire Al- : DUpdate Existing ❑New System 0 Not Req'd AND 0 Is loc• ed in this folder <br /> C emical Sup: DUpdate Existing ❑New Sy em 0 Not Req'd 0 I n a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes:via{ 14AQ K Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: L 'ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL irk] <br /> ct \NeliVRA4- <br /> Additional Notes: Y'"' <br /> Approved By: Date: Approved By: Date: <br /> 2 <br />