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Intake & Approval Sheet 10 (FOR PERMIT STAFF ON09 PERMIT # b10C) 2. 00l <br />BUILDING <br />Intake OK by: z:nw Date: 2— <br />Intake Comments: <br />❑ Route to CommercialBuilding <br />Route to Residential Building <br />Make this a "W"Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />1 <br />Basement <br />❑No Dies , / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System []Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? []Yes &No <br />Add'( RCW 64.55 docs required prior to final? ❑Yes PgNo <br />VALUATION CALCULATION: Total $ --Z—d—,M(/J" <br />Additional Notes: Z©ls- /o2G 4t W<i Ec <br />Approved By: Date: = Zd <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />OFire 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 />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />4 Intake OK by:_ _ Assign To: , Date: Z- 3-10 <br />Intake Comments: <br />1(0 �5 _ � b� 5, e ja�.. <br />�o Z � 5 ar P�awS <br />a��!A) re'.31Y a -�o <br />❑ Attach to Project No. <br />Route to Historic Reviewer <br />;r1OK 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? ❑Yes VNO <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By: 'Date: <br />PUBLIC WORKS <br />Intake O by: Date:_ <br />_...._..._.,.,.............. ... ,.,,,,,..,.,,.,,,......... ................. <br />Intake Co I PW Worksheet Needed if., <br />:0Sys Dev Eval ❑Traffic Mit Eval <br />OSite Work or Drainage Proposed <br />❑Back -flow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />i...... ........ ..................................................... <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 Qoin 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 NJ Required <br />Additional Note . 6Z Z4 2oZo <br />Approved By: Date: <br />z/y <br />