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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# <br /> BUILDING / <br /> PLANNING/ I 1 <br /> Intake OK by: Date: Intake OK by: V Y Date: `-P 1 f <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 Y, <br /> — <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 I =pection Required before Final? ❑YesNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System DNot Req'd School Impact Fe Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett hool Dist ❑Mukilteo School Dist <br /> Add'!RCW 64.55 docs required prior to final? ❑Yes El No Additio =I Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved By: Date: (f <br /> PUBLIC WORKS <br /> Intake OK by: "Tr..1 Date: is? 4 17v I q <br /> Additional Notes: >ac- :.ae2 ST "CIt-"e' Intake Comments: PW Worksheet Needed if: <br /> (z- <br /> c7-4.)Gr ❑Sys Dev Eval DTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: (o �1(c� ►tel o T'� Sc_c,�� ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT CI Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 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 (4/Zo/q <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />