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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT # V2 - (50'2— <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/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 El New System <br />❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System <br />❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes <br />❑ No <br />Add'I RCW 64.55 does required prior to final? []Yes <br />[]No <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: <br />1.07ZDate: 10 <br />l <br />0+ <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />.f <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: <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. 5E?,4 �i L/ <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 />t <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? KYes ❑No <br />"In Lieu" Fee: Type: Amoun <br />School Impact Fee: Total $ <br />Calculated: Cr <br />❑Everett School Dist ❑Mu ' eo School Dist <br />Additional Notes: <br />��t•,/�a� 1 V1�fi�CY� <br />Approved By: Date: <br />UBLIC WORKS <br />Intake OK by: Date: <br />:........................................................... . ............................... <br />Intake Comments: IPW Worksheet Needed if. <br />f ❑Sys Dev Eval ❑Traffic Mit Eval <br />=Site Work or Drainage Proposed <br />=ClBackflow 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 El Deferred <br />This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />JR(A Separate PW Permit is Required (Permit #: PWO("01A_) <br />AND ❑ Is located in this folder <br />❑ Is inS� Green Folder Coin with this folder for permit issuance) <br />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: S <br />