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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT #1��� C)2\ <br />BUILDING <br />Intake OK by: C417 Date: 8 <br />Intake Comments: <br />VT Route to Commercial Building (574c, C-7-UKAL,1 <br />ER Route to Residential Building J/ <br />❑ Make this a "W" Permit <br />d I/Addn/Rem Size <br />6 <br />Garage essory truct. Size <br />$15 <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing El New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? Yes 19No <br />Add] RCW 64.55 docs required prior to final. ❑Yes <br />o <br />VALUATION CALCULATION: Total <br />361 a f2-r545 D w� <br />360 @ 25 <br />Additional Notes: 2 /5 !QC 10SrL <br />Approved By: Date: SJ 2—O <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 />❑ 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: Date: T, O�(: �\d\q\ <br />Intake Comments: Assign To: \acG <br />A4 <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 />—� <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />�2 <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 Date:©, Z ZQ\� <br />PUBLIC WORKS <br />Intake OK by Date: 4 <br />;------------I---------------------------- <br />Intake Comments: ;PW Worksheet Needed if.• <br />- LrA'o T. o J ; ❑Sys Dev Eval El Traffic Mit Eval <br />S C,_ A 2-.A G f MiSite Work or Drainage Proposed <br />�t 4•oaoSE� "DEC,- tS ❑Backflow Prevention for high hazard: <br />OMC-c- G-, S CVPra..ilr r,_ :(dental, medical, animals, mortuary, hospital, <br />¢eOr ;supportive housing) <br />'-------------------------------- <br />QRoute 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 />❑ 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: le> Z 3 7 <br />