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Intake & Approval Sheet l& (FOR PERMIT STAFF ONLY) i PERMIT # blo 1 0— ®' P <br />BUILDING .: <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ e this a "W" Permit <br />Bld I/ do/Rem Size <br />3/Z <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />Z q <br />Occupancy Group <br />Occupancy Load <br />.� <br />Fire Sprinklers: Rupdate Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: KUpdate Existing ❑New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $ Z®4 '.0 <br />Additional Notes: <br />Approved Date: /o <br />FIRE DEPARTMENT <br />Sate / Deferred Submittals Required: <br />Xre Sprinklers 4Fire 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 />ER / Inspection Scope - ADD FIRE FEE <br />IReview <br />Approved By: <br />Date: — <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <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 />v <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 ONO <br />"In Lieu" Fee: Type: Amou <br />School Impact Fee: Total $ <br />Calculated: Cre <br />❑Everett School Dist ❑Muki o School Dist <br />Additional Notes: ,h�E•a1ia� ��7plW anL) <br />Approved By: Y, Date: V3.1. Z c> <br />UBLIC WORKS <br />Intake OK by: Date: <br />»,,,»,............ m»,................... ......,,,,,»,,,.»....................... ....................................... ........... ......... <br />Intake Comments: PW Worksheet Needed if: <br />3 <br />g ❑Sys Dev Eva] ❑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 />€».,.,»,,,.»....»....................._..........»,.»..,,.»,,,,.......,.....,»...,.,.,,.,,,,,.......................»..-... <br />El 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 />�I❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />blic Works has no scope --- PW Not Required <br />Itional Notes: <br />Approved By: Date: <br />