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J <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLr <br />PERMIT #' \ OL� —Q ( <br />BUILDING <br />Intake OK by: Date: .4-1 <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 OYes Fi / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑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'I RCW 64.55 docs required prior to final? ❑Yes PNo <br />VALUATION CALCULATION: Total $ <br />`kS �c l 2A = 23595 <br />k(,2MKSp 20co <br />Additional Notes: 2-0l5- SAC J�' <br />Approved By: <br />Date: Z 3 <br />FIRE DEPARTMENT <br />Separate / 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: <br />Date: LA OA - mkq <br />Intake Comments: <br />Assign To: 14 <br />\a� C 4119-NcctiS <br />QJCAaX La'.v\\QJ' <br />❑ Attach to Project No. <br />wer <br />® OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />" <br />Overlay/Agreement <br />�' " , <br />�wA <br />12 , ��r�� <br />\�,4, <br />Residential Use <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: <br />Amount $ <br />School Impact Fee: Total $ <br />Calculated: <br />Credit: <br />❑Everett School Dist ❑Mukilteo <br />School Dist <br />Additional Notes: <br />Approved By. '- - <br />Date: j <br />PUBLIC WORKS <br />Intake OK by: Date: <br />•----------- - --------- ---------------- <br />Intake/ Comments: j �;PW Worksheet Needed if. � <br />Ai A) �) : ❑Sys Dev Eval ❑Traffic Mit Eval <br />; []Site Work or Drainage Proposed <br />Sur a ` '� : ❑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 Coin with this folder for permit issuance) <br />❑ WIII 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: <br />!� <br />