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Intake :. Approval Sheet (- r1 <br />PERMIT # v 1" ►W' W& <br />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 />Bldg/TI/Addn/Rem Size <br />2-I5q 0 <br />Garage/Accessory Struct. Size <br />4111 0 <br />Number of Stories <br />2— <br />Basement <br />1ANo ❑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 />Add'I RCW 64.55 dots required prior to final? ❑1 ❑No <br />rY�es <br />VALUATION CALCULATION: T�oAt�all $G <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Intake: (Needed for Townhomes, Alley load SFR, New Commercial) <br />❑Route to Fire Drawer --- Fire Preliminary Review Notice <br />El Sending Fire Notes to Project Team <br />Date: (OK to Route to Other Departments) <br />Fire Sprinklers: ❑Update Existing El New System ❑ Not Req'd <br />Fire Alarm: ❑Update. Existing ❑New System ❑ Not Req'd <br />Chemical Sup: El Update Existing ❑New System ❑ Not Req'd <br />Additional Notes: <br />"nproved By: Date: <br />TApprovproved <br />ELECTRICAL <br />ditional Notes: <br />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 />Overlay/Agreement <br />YDD <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 YNO <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $_ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: --- <br />Approved Date: 10 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />•----------------------------------------- <br />Intake Comments: ;PWWorksheet Needed if. <br />❑Sys Dev Eval ❑Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />T(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />I ----------------------------------------- <br />❑ Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder [Submitted Previously El Deferred <br />53:This Permit is Approved by Public Works <br />CR See PW Review Worksheet and associated attached items <br />9A Separate PW Permit is Required (Permit#: PW101110—Oq$ ) <br />AND '9is located in this folder <br />❑ Is in a Separate Green Folder Goin 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:L01 <br />L�2 <br />