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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT # s 2-IM- o <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 El 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 />Add1 RCW 64.55 docs required prior to final? ❑Yes ❑ No <br />VALUATION CALCULATION: Total $_�? 2 Y <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 ToAu/w Date tv " <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ g ute to Historic Reviewer <br />to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />art, 1� <br />Nonresidential Use . <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Requir fore Final? ❑Yes ONO <br />"in Lieu" Fee: Type: Amount $ <br />School Impact Fee: To $ <br />Calculated: Credit: <br />❑Everett ool Dist ❑Mukilteo School Dist <br />Addi ' al Notes: <br />Approved By: Date: W �0 <br />PUBLIC WORKS' <br />Intake OK by: Date: <br />_._.........__�..,..,............... ,,,,,,,,,,,,,..... .... <br />_,m.,..,.,.._...,......,.......,_. <br />Intake Comments: PIN Worksheet Needed if. <br />[]Sys Dev Eval ❑Traffic Mit Eval <br />=0Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />'(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />@...........,................... .......................... ..........................,...,,,,,...,,,.............................. ............ .... <br />. <br />❑Route this folder for PW Review at end --- PW Review Worksheef <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder []Submitted Previously ❑Deferred <br />❑ This Permit is Approved by Public Works <br />❑ See 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 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: J2k <br />