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Intake & Approval Sheet 10 (FOR PERMIT STAFF ONLr 0 PERMIT #�)k -0 2 <br />BUILDING <br />Intake OK by: Date: <br />Intake Commen s S5>l4t" -110 <br />Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />A- <br />Garage/Accessory Struct. Size <br />Number of Stories <br />1F- <br />Basement <br />❑No 0-Yes, Fin / Unfin <br />Type of Construction <br />V1A <br />Occupancy GroupL <br />;L <br />Occupancy Load <br />77- <br />Fire Sprinklers: El Update Existing ❑New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: 0Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />rrppII <br />RCW 64.55 MF worksheet req'd for permit? []Yes No <br />Add'I RCW 64.55 does required prior to final? []Yes MNo <br />VALUATION CALCULATION: Total $i-r,5,0 CM2 <br />Additional Notes: <br />Approved By: Date: at <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />"Y <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />inimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By:\CV-)U&d)(� Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />use Vu. A\A <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning Fite Drawer <br />Zone <br />cam, 3` r'° <br />�► e <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />El Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By Date: ,,'U3' to \9 <br />PUBLIC WORKS <br />Intake OK by: Date: 7i0 <br />.......................-.......... ... <br />.. ........ _... ......... _.- ....... .......... <br />_..- ._ <br />Intake Comments: 1PIN Worksheet lNeeded if., <br />r _ (,(,�� I]Sys 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 />e............... ....... ........................... ...................................................................................... <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 El 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 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:LLL Date: it I Zpl <br />