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Intake & Approval Sheet <br />'i i <br />(FOR PERMIT STAFF ONLY) <br />PERMIT # / j,f t-6a f <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 />Bldg/TI/Addn/Rem Size <br />w <br />Z.rj o3 (P <br />Garage/Accessory Struct. Size <br />45cl 141 <br />Number of Stories <br />2- <br />Basement <br />®No []Yes, Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? Dyes ❑ No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $. ?A 6 1 5'ib <br />15 I�G U7 6C� <br />Additional Notes: <br />Approved By: Date: 10 <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 />0 proved 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. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />L <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 NrNo <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: LIDLI <br />PUBLIC WORKS <br />Intake OK by: Date: <br />------------------------- ---------------- <br />Intake Comments: ;PWWorksheetNeeded if. <br />[]Sys Dev Eval ElTraffic 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 />E]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 />RSee PW Review Worksheet and associated attached items <br />KA S;e..paa ate PW Permit is Required (Permit #: PW PTO m <br />AND �I 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: �`q <br />