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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONL19 <br />• <br />PERMIT # <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 />Bld I/Addn/Rem Size <br />G ra Accessory Struct, Size <br />Number of Stories <br />1 <br />Basement <br />No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />S— <br />Occupancy Load <br />�1 <br />Fire Sprinklers: ❑Update Existing []New System PNot 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 P1No <br />Add'I RCW 64.55 docs required prior to final? Dyes No <br />VALUATION CA CULATION: Total $_dMP116 2 SSA. cc <br />Additional Notes: <br />Approved By: Date: e97 /6/7�y� <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: Assign To:Date: <br />Intake Comments: <br />S-Q0 �N 1&tr <br />❑ 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? []Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By: 91 Amate: <br />o/ <br />PUBLIC WORKS <br />Intake OK by: Date: <br />:........................................................................................................................................... <br />Intake Comments: PWWorksheetNeeded if. <br />• <br />[]Sys Dev Eva ❑Traffic Mit Eval <br />I ❑Site 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 ❑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 #: PWwoi- 01 el � <br />AND 21-ts located in this folder <br />❑ Is in a Separate Green Folder (join 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 />Approved By: Date: 0-7 e; 2.4 t > <br />