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Intake & Approval Sheet - (FOR PERMIT STAFF ON09 • PERMIT # E? <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 />Garage/AccessoryStruct. Size. <br />Number of Stories <br />4 <br />Basement <br />10No ❑Yes , Fin / Unfin <br />Type of Construction <br />�{ <br />Occupancy Group <br />t2- <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing New System ❑Not Req'd <br />Reason Sprinklers Required: '�r_L0lr, <br />Fire Alarm: El Update Existing EN New System ❑Not Req'd <br />Reason Fire Alarm Required: 5-61C <br />RCW 64.55 MF worksheet req'd for permit? FDYes ❑ No <br />Add'I RCW 64.55 docs required prior to final? MYeS ❑No <br />VALUATION CALCULATION: Total $_ Blao <br />44�-t©�F <br />Additional Notes: <br />Approved By: Date: &o Le <br />LIE <br />FIRE DEPARTMENT <br />Intake: (Needed for Townhomes, Alley load SFR, New Commercial) <br />❑ Route to Fire Drawer --- Fire Preliminary Review Notice <br />❑Sending Fire Notes to Project Team <br />Date: (OK to Route to Other Departments) <br />Fire Sprinklers: ❑Update Existing Ehew System ❑ Not Req'd <br />Fire Alarm: ❑Update Existing-91New System ❑ Not Req'd <br />Chemical Sup: ❑Update Existing El New System ❑ Not Req'd <br />Additional Notes: <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date: <br />Intake Comments: Assign To - <br />® Attach to Project No. SEfAM� — 0\2� <br />Voute to Historic Reviewer <br />K to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />N� <br />Residential Use <br />VW <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />a <br />Planning/Landscape Inspection Required before Final? Myes ❑No <br />"In Lieu" Fee: Type: Amount $ r <br />School Impact Fee: Total $ �(fl! <br />. <br />Calculated:l5_Cp .x3,23�-Credit: \� <br />NEverett School Dist ❑Mukilteo School Dist <br />Additional Notes: �;Qe. I Fl imp h )XV(�j� <br />�f�� <br />Approved <br />Date: 22 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />----------------------------------- ------ <br />Intake Comments: ;PW Worksheet Needed if. <br />❑Sys Dev Eval ❑Traftjc Mit Eval <br />:OSite Work or Drainage Proposed <br />❑Backflow 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 />9See PW Review Worksheet and associated attached items <br />39 A Separate PW Permit is Required (Permit #: PW i$o "ill <br />AND ❑ Is located in this folder <br />1:1 <br />Is in a Separate Green Folder (join with this folder for permit issuance) <br />RSl 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: <br />F 2j , <br />