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Intake & Approval Sheet * (FOR PERMIT" STAFF ONLr <br />PE�7 �, k9 � 0 — 0 q, <br />BUILDING <br />Intake OK b Date: A LZ <br />Intake Comment <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Add m Size <br />Garage/Accessory ruct. Size <br />Number of Stories <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction <br />V <br />Occupancy Group <br />- Z_ <br />Occupancy Load <br />Yo <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 2 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes 4No <br />VALUATION CALCULATION: Total $G� <br />Additional Notes: , <br />Approved r z Date: <br />901 <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 S ope - ADD FIRE FEE <br />Approved B Date: (( 26 <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLAN ING <br />Intake OK b Assign T : ate:Z <br />Intake Comments: <br />KU 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 />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? Wes L_ 'Vo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: AAjIL4_ <br />vs4At�. <br />Approved By:r Date: <br />PUBLIC WORKS <br />Intake OK by: 6 Date: 10 'L2 / °l <br />.... .._............... .Y................ ................... w.......... .................. <br />_..........,....,....._...,....,.,.,..... <br />Intake Comments: -PW Worksheet Needed if. <br />Ck t S 4ys Dev Eva[ NfTrafric Mit Eval <br />-iSA o� uAL.+ArT•s#. <br />WSite Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />-supportive housing) <br />€......._........................... ............................................................................................................. <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 JKCreate Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />6A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />L:xIs in a Separate Green Folder Coin with this folderfor 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 />A <br />pproved Date: 3EL(o <br />