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Intake & Approval Sheet *(FOR PERMIT STAFF ONLr PERMIT # PWzDto'
<br />BUILDING
<br />Intake OK by: Date:
<br />Intake Comments:
<br />❑ Route to Commercial Building
<br />❑ Route to Residential Building
<br />❑ Make this a "W" Permit
<br />Bldg/TI/Addn/Rem Size
<br />j-
<br />Garage/Accessory Struct. Size
<br />—
<br />Number of Stories
<br />2
<br />Basement
<br />[]No ❑Yes , Fin / Unfin
<br />Type of Construction
<br />y — f
<br />Occupancy Group
<br />K--�
<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 91 No
<br />Add] RCW 64.55 docs required prior to final? ❑Yes IoNo
<br />VALUATION CALCULATION: Total $
<br />4.6 k -71
<br />Additional Notes:
<br />Approved By: Date: VI
<br />FIRE DEPARTMENT
<br />Separate / Deferred Submittals Required:
<br />❑Fire Sprinklers ❑Fire Alarm ❑Other:
<br />Additional Notes: 7,
<br />Fire Dept. Fees:
<br />❑ Review of As-Buil/Plans- EFEE
<br />Minimal or No FirRE FEE
<br />❑Review/ InspectiFIRE FEE
<br />Approved By: Date:
<br />ELECTRICAL
<br />Additions otes:
<br />Appro ed 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 />Overlay/Agreement
<br />Nonresidential Use
<br />Residential Use
<br />�(
<br />Proposed No. of Dwelling Units:
<br />---
<br />Total No. of Dwelling Units:
<br />3
<br />Planning/Landscape Inspection Required before Final? Yes RINo
<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: c Date: `(Q,ZQ).Z.Gf
<br />PUBLIC WORKS
<br />Intake OK by: Date:
<br />:_..,,,,,._,..-,,.,,,,,.,,.,...-..-...Y....,.,,.._..,.,.,.,..-,,,,,,,,,,,,,,,,,,,,.... ...,.................
<br />Intake Comments: DPW Worksheet Needed if.•
<br />OSys Dev Eval ❑Traffic Mit Eval
<br />❑Site Work or Drainage Proposed
<br />ElBackflow 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: to 2Y
<br />f 2.v
<br />
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