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Intake & Approval Sheet r (FOR PERMIT STAFF ONLY) . . PERMIT # 0 l �12-OC4 <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 />lg <br />Bldg/TI/Addn/ ize <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No WYeS <br />Fin Unfin <br />Type of Construction <br />ME <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System <br />❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System <br />❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes K <br />No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes &[No <br />VALUATION CALCULATION: Total $ <br />O <br />Additional Notes: <br />Approved By: Date: 2-12..&ZZq <br />FIRE DEPARTMENT <br />Intake: (Needed for Townhomes, Alley load SFR, New Commercial) <br />❑ Route to Fire Drawer --- Fire Preliminary Review Notice <br />❑Sending Fire Notes to Project Team <br />Date: (OK to Route to Other Departments) <br />Fire Sprinklers: ❑Update Existing ❑New System ❑ Not Req'd <br />Fire Alarm: ❑Update Existing ❑New System ❑ Not Req'd <br />Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd <br />Additional Notes: <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes:. <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date: 1 L - <br />Intake Comments: Assign To: aCQ IP <br />'n4a ' m COAACA t`2 <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />I@ OK to Route to Other Departments <br />El Hold in Planning File Drawer <br />Zone <br />' 2 <br />Overlay/Agreement <br />— <br />Nonresidential Use <br />�- <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Q <br />Total No. of Dwelling Units: <br />4SF�. -�- <br />Planning/Landscape Inspection Required before Final? s 191No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ Z 10&ft <br />Calculated: � nI-, Credit: <br />❑Everett School Dist IRMukilteo School Dist <br />Additional Notes: %JJ'.20\QO`�t'3d0033 <br />Approved By: Date:,3Q, 2O�G <br />PUBLIC WORKS <br />Intake OK by: 'T'4 Date: 12 / r-r 12o IS <br />- <br />-------- --- ------------------- - ---------- <br />Intake Comments: ; PW Worksheet Needed if.• <br />.CotivC-a- 'BAs>E.*Af j— Tc-1 ; U94p Dev Eval ❑Traffic Mit Eva[ <br />F, vv . ; ❑Site Work or Drainage Proposed <br />,Mo 63-YO- Wncc-c- TvL6vbste ❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <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 />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 />it <br />Approved B Date: $h7 Zot q <br />