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5o l 46i 1210- 002- 1 <br />Intake & Approval Sheep W (FOR PERMIT STAFF ONLY) PERMIT # G l <br />BUILDING <br />Intake OK by: Date: <br />ake Comments: <br />® Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />BldgfTI/Addn/Rem Size <br />(p2 <br />Garage/Accessory,Struct. Size <br />Number of Stories <br />Basement <br />1ANo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: [JUpdate Existing ❑New System El 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 />Add] RCW 64.55 docs required prior to final? ❑r Yes ❑No <br />VALUATION CALCULATION: Total $ 7j 53 ,"1 0-00 <br />05 Ir J--1V ►� <br />Additional Notes: <br />Approved By: Date: z,3 <br />FIRE DEPARTMENT <br />Intake: (Needed for Townhomes, Alley load SFR, New Commercial) <br />❑ Route to Fire Drawer --- Fire Preliminary Review Notice <br />❑Sending Fire Notes to Project Team <br />Date: (OK to Route to Other Departments) <br />Fire Sprinklers: ❑Update Existing ❑New System ❑ Not Req'd <br />Fire Alarm: ❑Update Existing ❑New System ❑ Not Req'd <br />Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd <br />Additional Notes: <br />oproved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date: <br />Intake Comments: Assign To: <br />Attach to Project No. C7 \A I I o oy <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 />�— <br />Residential Use <br />Gj <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />dNol <br />Planning/Landscape Inspection Required before Final? ❑Yes <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: ' <br />PUBLIC WORKS <br />Intake OK by: Date: <br />-- ------------------------------------- <br />Intake Comments: ;PWWorksheetNeeded if.- <br />❑Sys Dev Eval ❑Traffic Mit Eva] <br />❑Site Work or Drainage Proposed <br />ElBackflow 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 />This Permit is Approved by Public Works <br />ffSee PW Review Worksheet and associated attached items <br />XA Separate PW Permit is Required (Permit #: PW I,iOq 5 ) <br />AND 191s located in this folder <br />❑ Is in a Separate Green Folder (join 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 />Z/ <br />