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Intake & Approval Sheet 6 (FOR PERMIT STAFF ONLV) 10 PERMIT #�?\_\ 0 _ 0*� <br />BUILDING <br />Intake OK by: Date:iols—oza <br />Intake Comments: <br />❑ Route to Commercial Building <br />54 Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TIJAMRem Size <br />36 6 $Jz. <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / 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 ❑New System ❑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 $ 44 <br />Additional Notes: 2_016- kv cdc. <br />Approved By: Date: 2Z <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El 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: 1 2 3 <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: )(A- Assign To: �0 Date: dbL 30 aIq <br />Intake Comments: �0_4 WIN <br />bo-�ee�V12u"YCj'� <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 />-- <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes MO <br />"In Lieu" Fee: Type: Amoun <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo S ool Dist <br />Additional Notes: 0,j i <br />iApproved By: Date: Z. , <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Worksheet Needed if: <br />�/ ❑Sys Dev Eval ❑Traffic Mit Eval <br />:)]Site Work or Drainage Proposed <br />=1113ackflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />j supportive housing) <br />:.._......_........................._........_..................................................._.......................... <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 3 <br />.. <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: Date: `ti - 201� <br />