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Intake & Approval Sheet FOR PERMIT STAFF ONLY PERMIT # ° � I I— Q` <br />NM ( ) <br />BUILDING <br />Intake OK by: ICP Date: I I of <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 />G ft <br />Number of Stories <br />Basement <br />RNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Ite <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: El Update Existing El New System E4Not 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 13 No <br />Add] RCW 64.55 docs required prior to final? ❑Yes EINo <br />VALUATION CALCULATION: Total $ ZRt 376 <br />Additional Notes: <br />Approved By: Date: z4y <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 />�L y <br />Intake OK by: Date: 1�•Z�- l`� <br />Intake Comments: Assign To: A. <br />' Ci.1Gs <br />tkq , o� #44-a� r. Pi ar5 <br />Attach to Project No. lq—yZZ <br />Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />- <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: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: -- ZE'% rY <br />------------ -- ------------------------- <br />Intake Comments: ; PW Workshe&t N eded if. <br />R�g Sffl Sys Dev EvX E]Trac Mit Eval <br />q?5?5� Q/'2�, o-fie ite Wor or e <br />/ j �3 �S• —��.�f`r l]Backflow Prevention for high hazard: <br />:(dental, medical, animals, mortuary, hospital, <br />j fly( ���Illfi� :supportive housing) <br />wrif� �GJ�FJLm►f - 5W-S�666:----------------------------------------- <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 RCreate Green Folder ❑Submitted Previously ❑Deferred <br />,This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />14 A Separate PW Permit is Required (Permit #: PW Ztt7V <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: �% �, <br />