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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT # YJ lJ�d\ �3 <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 />I <br />Basement <br />SNo []Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />14 <br />Fire Sprinklers: ❑Update Existing ❑New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: [-]Update Existing ❑New System -0Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? []Yes L7 No <br />Add'I RCW 64.55 docs required prior to final? []Yes No <br />VALUATION CALCULATION: Total $ rj <br />Additional Notes: <br />Approved By: Date: T Zo7� <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 />0-Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Y Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Date: <br />Zone <br />1 <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />J <br />I <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes o <br />"In Lieu" Fee: Type: <br />Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo S <br />of Dist <br />Additional Notes: <br />0.5 <br />(16W <br />OA- (615 <br />Approved By: <br />Date: q , <br />, 7,1 <br />UBLIC WORKS <br />Intake OK by: Date: <br />...................................................................................................................... <br />Intake Comments: I PW Worksheet Needed if.• <br />❑Sys Dev Eval ❑Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />:(dental, medical, animals, mortuary, hospital, <br />;supportive 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 []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: ��� �: Dater z I <br />4J <br />