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• <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT #J� <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 />Bld TI/Addn/Rem Size <br />Z� <br />a e/ ccesso Struct. Size <br />'OS 23 JZ <br />Number of Stories <br />Z <br />Basement <br />2TNo ❑Yes , Fin / Unfin <br />Type of Construction <br />a ,g <br />Occupancy Group <br />(� <br />Occupancy Load - <br />Fire Sprinklers: ❑Update Existi News Ste )t Ran? <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing New System <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? Yes LTNo <br />Add'I RCW 64.55 docs required prior to fin*?,"[]Yes ONo <br />VALUATION CALCULATION: T , $ 3ag 8I7 <br />tv s � <br />�I UV ►W� <br />Additional Notes: <br />Approved By: Date:3 Za 20 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers El Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE `� I`P4 eiJ <br />l��Review/Inspection <br />Minimal or No Fire Scope - NO FIRE FEE/YX <br />Scope -ADD FIRE FE�Vrl <br />Approved By: <br />Date: 1`2 <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 />1 <br />Total No. of Dwelling Units: <br />�— <br />Planning/Landscape Inspection Required before Final? es ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: �N t2� Credit: <br />Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: ('S rb <br />r <br />Approved By: k Date: I <br />PUBLIC WORKS <br />Intake OK by: Date: <br />............................................. ...... ..... ..... ...... ............,....... ...... ..... ............ ..... ..... ...... ..... ..... <br />Intake Comments: PIN Worksheet Needed if: <br />[]Sys Dev Eva []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 />❑ 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 />O-A Separate PW Permit is Required (Permit #: PW 2 �io - oZS ) <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:`=�f Date: ,�: ;L!:-d_► <br />