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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# €\ 61 (:) *--00(.0 <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 r=i OK to Route to Other Departments f CC.t' t g)S.Z0 i <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone 11- i <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 ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes ril-No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update 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? ❑Yes 0 No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> Approved By: IL-, y)\ Date: Li - I(c,-I 9 <br /> PUBLIC WORKS <br /> Intake OK by: _5464' Date: <br /> Additional Notes: Intake Comments: PW Works eetNeeded if: n%8- <br /> SI nn n(A� has n0 ❑Sys Dev Eval ❑Traffic Mit Eval <br /> � 'vw L- m ❑Site Work or Drainage Proposed <br /> Approved By: Date: 4Ig�R a `� ��I! }�' ❑Backflow Prevention for high hazard: <br /> fff r ���!l" (dental,medical,animals,mortuary,hospital, <br /> �{, supportive housing) <br /> FIRE DEPARTMENT ItIRoute this folder for PW eview at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers El Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: gThis Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> 0 Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD FIRE FEE 0 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: r 'Vn,�tl1r,),,,,,, ,,o,-,d ,,,iELECTRICAL I t vk-- V l CARP lac <br /> Additional Notes: 'j�� <br /> Approved By: Date: Approved By: Date: //yl ? <br />