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Intake & Approval Sheet PERMIT STAFF FOR ONLY) 0 PERMIT # � w \ 1 \2 -0 <br />r � <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 El 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 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 />❑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: Date: <br />Intake Comments: <br />CI Attach to Project No. ��� ! 00 <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 />u <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />.-------. <br />Planning/Landscape Inspection Required before Final? ❑Yes o <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ i2n - <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: — ---- <br />Approved Date: 2 2 Y 2 O <br />PUBLIC WORKS <br />Intake OK by: i t-1 Date: f� 23 20 i S <br />... ...... .... .... .._,_._..........,.._................,_.,...,,.,..,.......... .,..,.............. .... ..,.............. <br />.. <br />Intake Comments: PW Worksheet Needed if.• <br />' ��►�� S sa b s r�:o*a IWys Dev Eval ❑Traffic Mit Eval <br />Site Work or Drainage Proposed <br />1113ackflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />(-�e pv Ec. ,k�,prsupportive housing) <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 reate Green Folder []Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />UK —be 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 folderforpermit 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: 2 ?—(. (�jp <br />