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Intake & Approval Sheet 0 <br />0 <br />(FOR PERMIT STAFF ONL r <br />PERMIT #e _tgO-q ` 00'i <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />XRoute to Residential Building <br />❑ Make this a "W" Permit <br />Bldgffl dd Re Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />1 <br />Basement <br />1KNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing El New System El 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? ❑Yes No <br />VALUATION CALCULATION: Total $ (Z„Z, �03 <br />4 72 8 (, 3rZ <br />G ?? 46,31� <br />Additional Notes: 7 01 S, <br />Approved By: <br />Date: '7 Z3 �q <br />FIRE DEPARTMENT <br />Separate i Deferred Submittals Required: <br />El 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: Date: <br />Intake Comments: Assign To:��X <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 />Nonresidential Use <br />Residential Use <br />f A ry, <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 D' ❑Mukilteo School Dist <br />Additional No <br />Approved By: <br />Date: 112,A <br />O <br />lid <br />PUBLIC WORKS <br />Intake OK by: __." Date: `1 GS Zt�l.9 <br />----- ---- ---------------------------- <br />Intake Comments: ;PW Worksheet Needed if.• <br />5 a a ► Jb <br />iR ot� eao : t=c M_ - ; .Sys Dev Eval ❑Traffic Mit Eval <br />�'` �t'*�'-per �-i • ; NSite Work or Drainage Proposed <br />- ❑Backflow Prevention for high hazard: <br />{4 q w.v Sv csF A c E (dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />•1R �-O (w p�.tsOt�(O w.1 '----------------------------------------- <br />oute 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 />his Permit is Approved by Public Works <br />-See PW Review Worksheet and associated attached items <br />Separate PW Permit is Required (Permit #: PW I q10 - 03-3 ) <br />AND Etts 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: /.a �9 <br />