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Intake & Approval Sheet
<br />AD (FOR PERMIT STAFF ONLY) !
<br />PERMIT # t✓)
<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[fl/Addn/Rem Size
<br />�( j
<br />Garage/Accessory Struct. Size
<br />-----
<br />Number of Stories
<br />ct "� �®^p� 04
<br />Basement
<br />WNo ❑Yes , Fin / Unfin
<br />Type of Construction
<br />/-T"� A
<br />Occupancy Group
<br />.�.�L� '4Z
<br />Occupancy Load
<br />%SJG
<br />Fire Sprinklers:;KUpdate Existing ❑New System ❑Not Req'd
<br />Reason Sprinklers Required:
<br />Fire Alarm: Update Existing ❑New System ❑Not Req'd
<br />Reason Fire Alarm Required:
<br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 70 No
<br />Add'I RCW 64.55 docs required prior to final? ❑Yes No
<br />VALUATION CALCULATION: Total $
<br />Additional Notes:
<br />Approved By: Date: t o
<br />FIRE DEPARTMENT
<br />Serate I Deferred Submittals Required:
<br />rre Sprinklers ire 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 />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.
<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:
<br />Approved By: Dat .
<br />PUBLIC WORKS
<br />Intake OK by: Date:
<br />_ .............. .......... ,,,.,......,,..,.,...,.....,..,,,,,,,,,,,,,..,..,..,,,,,,,.....,....,..,.,.,........................
<br />.,,.,,..,
<br />Intake Comments: !PW Worksheet Needed if.,
<br />I
<br />0Sys Dev Eval OTraffic Mit Eva]
<br />[]Site Work or Drainage Proposed
<br />=�Backflow Prevention for high hazard:
<br />(dental, medical, animals, mortuary, hospital,
<br />(supportive housing)
<br />..............,_,.........*...................................,..............,..................,...............................
<br />........
<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 M PW )
<br />AND ❑ Is located in this folder
<br />❑ Is in a Separate Green Folder (join with this folderfor permit issuance)
<br />❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg)
<br />1K Public Works has no scope --- PW Not Required
<br />Additional Notes:
<br />Approved By: Date:
<br />071
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