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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT # Kolcq_., d`
<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 />Bldg1TI/Addn/Rem Size
<br />Garage/Accessory Struct Size
<br />Number of Stories
<br />Basement
<br />❑No gYes, Fin / Unfin
<br />Type of Construction
<br />V1
<br />Occupancy Group
<br />Occupancy Load
<br />Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd
<br />Reason Sprinklers Required:r
<br />Fire Alarm: ❑Update Existing ❑New System El Not Req'd
<br />Reason Fire Alarm Required: ZX�
<br />RCW 64.55 MF worksheet req'd for permit? ❑Yes N No
<br />Add] RCW 64.55 docs required prior to final? ❑Yes No
<br />VALUATION CALCULATION: Total $_ ��0000, 00
<br />Additional Notes:
<br />Approved B . Date: 03 ?.fZ0
<br />FIRE DEPARTMENT
<br />Separate i Deferred Submittals Required:
<br />❑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 />29 Review / Inspection Scope - ADD FIRE FEE
<br />Approved By:
<br />K. 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 />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 []No
<br />"In Lieu" Fee: Type: Amount $
<br />School Impact Fee: Total $
<br />Calculated: Credit:
<br />❑Everett School Dist ❑Mukilteo School Dist
<br />Additional Notes: tibr `,001t- c9n - flo �iqv✓�� t
<br />Approved By: Date:
<br />PUBLIC WORKS
<br />Intake OK by: Date:
<br />.... ........ ,,..,,,,,,,,,,,,,,,,,,,,,,,,,,,,,...... .......
<br />,,,,,,...,.,,..,
<br />Intake Comments: PW Worksheet Needed if;
<br />[JSys Dev Eval ❑Traffic Mit Eva]
<br />j ❑Site Work or Drainage Proposed
<br />❑Backflow Prevention for high hazard:
<br />:(dental, medical, animals, mortuary, hospital,
<br />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
<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 folderfor permit issuance)
<br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg)
<br />ublic Works has no scope --- PW Not Required
<br />Additional Not /
<br />I "7 120 Zo
<br />Approved By: Date:
<br />24-
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