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Intake & Approval Sheet (FOR PERMIT STAFF ONLY9 <br />a <br />PERMIT # 0-ASQ'; oo2_ <br />BUILDING <br />5 � � <br />Intake OK by: Date:___ <br />Intake Comments: <br />❑ Route to Commercial Building <br />12 Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/0/1 I Size • <br />SO Z IS L <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />INNo ❑Yes , Fin / Unfin <br />Type of Construction <br />7-13 <br />Occupancy Group <br />R, <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />IpI <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes Irrc���F No <br />Add'] RCW 64.55 docs required prior to final? ❑Yes [RNo <br />VALUATION CALCULATION: Total 4.3 I <br />SSR @ f1V 4;Z,(31 <br />L 51- Q. *71 to, -7q s <br />Additional Notes: <br />sT)2 )ZEv : A <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 FI FEE <br />❑ Minimal or No Fire Scope - N IRE FEE <br />❑ Review /Inspection Scop - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date:— 1-7 h <br />Intake Comments: Assign To: GrAce <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />OK to Route to Other Department <br />Hold in P anning File lI eF I Drawer <br />Zone <br />` <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />rl e- `Y'AmI <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 />El Everett School Dist ❑Mukilteo School Dist <br />Additional `Notes: <br />L' ��"T�C.L'� Ql�,q S�c\J�S O`+19\\. 9Q. `�°�'e•� �,� <br />Approved By: ate: \ `� <br />PUBLIC WORKS <br />Intake OK by:-r 0 Date: S - 2;1'1 <br />Intake Comments: ; PW Worksheet Needed if; <br />s-pp�� C sCu SS�v, <br />-7'r O 5f #Aevj a o Sys Dev Eval UTraffic Mit Eva] <br />'.S Va..+FA cv'- ,AcL-f-* VCite Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />------------------------------------------ <br />ngRoute 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 />fa This Permit is Approved by Public Works <br />53.See PW Review Worksheet and associated attached items <br />V6 Separate PW Permit is Required (Permit #: PW 1 r1'tO <br />AND �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 B . —` Date: /O 2 Zo L4 <br />