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Intake & Approval Sheet $ (FOR PERMIT STAFF ®NLi9 * PERMIT # ?6,252 - 0.�( <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 />GaragelAccessory 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 ❑New System <br />❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El 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 priorto final? ❑Yes <br />❑No <br />VALUATION CALCULATION: Total $ Z©OZ <br />rOtl FA or (_6) <br />D(9 <br />Additional Notes: <br />Approved By Date: G Z <br />Z/OZ0 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />.x . <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 />Re-�_oo� onk) - 00- Car ► V <br />w''" ar lot—CoJarrj far - as, P`,",- <br />❑ A ach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />- <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />ow, - <br />I <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes VNo <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: Date: 2- ZI - Zo7,c7 <br />ty PUBLIC WORKS <br />Intake OK by: Date: <br />_.- ._......e.._.._....._.._.._._.-..._.._e...-.... ..-............................. . <br />Intake Comments: WINWorksheet Needed if.• <br />:Sys Dev Eval []Traffic Mit Eval <br />=0Site 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 />J- <br />rl <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 folder for 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: <br />t � <br />