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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONL)q 10 PERMIT # 1Y 1�Z1_ O uI
<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 ❑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 ❑ No
<br />Add1 RCW 64.55 docs required prior to final? ❑Yes []No
<br />VALUATION CALCULATION: Total $
<br />Additional Notes:
<br />Approved By: Date:
<br />FIRE DEPARTMENT
<br />Separate / Deferred Submittals Required:
<br />El Fire Sprinklers ❑Fire 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: ,6, Date: ? 2-7m
<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 />ivt� - (M X I' �✓� ✓1
<br />Overlay/Agreement
<br />Nonresidential Use
<br />TtSi?vamf Ace 6u,1 4 rt
<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: Date: �Z ZpLpj
<br />PUBLIC WORKS
<br />Intake OK by: Date:
<br />.........._..,.._ ..... ..-.-................ -,,,,,,,,,.,..,,,,.,,,,,.,-._,,,.,,,,,.,,.,,.,,,,.,........... ............. .....
<br />Intake Comments: PW Worksheet Needed if.•
<br />10Sys Dev Eval ❑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 />............................... .................................. ............ ......... ..... ............... .,.............................
<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 #: PW )
<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: Date: _
<br />
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