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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT # blJW Zl <br />c <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this "W" Permit <br />Bldg/TI/Add em Si <br />Jecl0,-/c <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />V,4 <br />Occupancy Group <br />�2 <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? Yes ❑ No <br />Addl RCW 64.55 does required prior to final? OYes []No <br />VALUATION CALCULATION: Total $r%O voe G© <br />Additional Notes: <br />Approved By Date:0S 7;a <br />k i <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />., . <br />Additional Notes: <br />Approved By: Date: <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? <br />s ❑No <br />"In Lieu" Fee: Type: Amo <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist Mukilteo School Dist <br />Additional Notes: <br />Approved By: Date: .� Zg',ZCjZd <br />Intake OK by: Date: <br />.....................,.......,, <br />Intake Comments: PWWorksheetNeededif. <br />=OSys Dev Eval ❑Traffic Mit Eval <br />;Site Work or Drainage Proposed <br />❑Backflow 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 />❑ This Permit is Approved by Public Works <br />❑ See PW Review worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ is located in this folder <br />❑ Is in a Separate Green Folder (join with this folderfor 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: <br />z�_ <br />