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Intake & Approval Sheet # (FOR PERMIT STAFF ONLI9 0 PERMIT #16 M+01 <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />qq.o 5.r <br />Number of Stories <br />Z <br />Basement <br />VKN.No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />r2Ul <br />Occupancy Load <br />Fire Sprinklers: El Update Existing ❑New System Wot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System [9Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes allo <br />Add'] RCW 64.55 docs required prior to final? ❑Yes INNo <br />VALUATION CALCULATION: Total $ 20 2 ,''77 2. <br />JZf52a17.1 175902- <br />LO `t @ 25 2 aop <br />3z @30 cl60 <br />�',O 40 23,520 <br />Additional Notes: if lorgc- <br />Approved By: Date: j <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />_X . <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />I. Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: — — <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK b Assign To: - \ Date: � <br />Intake Comments: <br />99Attach to Project No. <br />❑ Route to Historic Reviewer <br />® OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />- <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />©A <br />Planning/Landscape Inspection Required before Final? Wes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ T-ar , C� <br />Calculated: �•2�,�� Credit: <br />El Everett School Dist E4Mukilteo School Dist <br />Additional Notes: <br />` <br />Cr��-►ec�� O� S\C�YI.j use. A& <br />V <br />Approved B Date: , , ' <br />PUBLIC WORKS <br />Intake OK by Date: �f <br />/ Y .. _........... ...... _... _......... _.. _..... w..., ...._.................,.,...... <br />.. � ... <br />Intak Comments: PWWorksheetNeeded if.• <br />Bard sar-Aee & les on 110-7 <br />�S s Dev Eva] 0Traffic Mit Eval <br />��2)YY>9Gv ev ' 0Site Work or Drainage Proposed <br />013ackflow Prevention for high hazard: <br />,(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />his Permit is Approved by Public Works <br />&.See PW Review Worksheet and associated attached items <br />Separate PW Permit is Required (Permit #: PW 1911-62-p ) <br />AND 29-1• located in this folder <br />❑ Is in a Separate Green Folder (join with this folder for permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: Date:Yl <br />v <br />