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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (1\k1o(— ( 00 <br /> BUILDING , PLANNING <br /> Intake OK by: Date: l Intake OK 131 _____ Date: . S. Z 3 di <br /> Intake Comments. Intake Comments: Assign To: • • * i O A <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 C,OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone A— A <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, 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: ❑Update Existing ONew 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 ONew 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 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add''RCW 64.55 docs required prior to final? ❑Yes El No Additio I Notes: <br /> VALUATION CALCULATION: Total$ ,(' �y n <br /> Approved By:C--� -) Date: LA ,(0\( `''1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: / Vf/ZQ1/ <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: ARWE- <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: )4/ Date: i A ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute 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 /> El Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <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: ❑Update Existing ONew System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ONew System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ONew System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: n /zz <br /> Approved By: Date: Approved By: c� _ Date: // q <br />