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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />P-Make this a "W" Permit <br />Bld I/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />14,11114 <br />Number of Stories <br />Basement <br />No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />ys <br />Fire Sprinklers: ❑Update Existing ❑New System UNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing QNew System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 15 No <br />Add'[ RCW 64.55 does required prior to final? ❑Yes VNo <br />VALUATION CALCULATION: Total $ 74cwo &All <br />Additional Notes: <br />Approved BY0QDate046 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers 9FIreAiarm ❑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 />/ Inspection Scope - ADD FIRE FEE <br />Lview <br />vedBy: <br />Date: - - <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <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 />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 Dis <br />Additional Notes: <br />Approved By: Date: sZ <br />PUBLIC WORKS <br />Intake OK by:. Date: <br />W..,,._.__._.._._._.....___._............�................. I.....__....... <br />Intake Comments: =PIN Worksheet Needed if. <br />IElSys Dev Eva[ ❑Traffic Mit Eva] <br />-ElSite Work or Drainage Proposed <br />-ElBackf]ow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />...,...,.,.,.,...,,__.,.,.,.,.....,._.....,.,.,......,.,.....,.....,........�. ................. <br />El 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 Qoin 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: If, Z 4 t4A:_&�p <br />Approved By: Date: o <br />