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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />0 <br />PERMIT # <br />BUILDING <br />Intake OK by Date: 02-Z 7 ZOZD <br />Intake Comments: <br />4FP`r_c 1V7- fd Sildl`lY r SFIL 6A LCS . <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Id /'fl/Addn/Rem Size <br />Z, f <br />Garage/Accessory Struct. Size <br />Number of Stories <br />/ <br />Basement <br />0No ❑Yes , Fin / Unfin <br />Type of Construction <br />(� <br />Occupancy Group <br />a` <br />Occupancy Load <br />G <br />Fire Sprinklers: ❑Update Existing El New System Eallot Req'd <br />Reason Sprinklers Required: <br />rr� <br />Fire Alarm: ❑Update Existing Ef- New System []Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes [a No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ®NO <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By:- ,/, Date: �/i/ <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ElFire 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 />❑ 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 o <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />El Everett School Dist ❑Mukilteo School Dist <br />Additional � /N�ot�ejs: � - C. A55100C`5 60 <br />em(, 1-1-LIlsl��n •ZcQ <br />Approved By: Date: -2 <br />PUBLIC WORKS <br />Intake OK by: : N� Date: Z , 2� ,Z 2oU <br />,,...,......................... <br />Intake Comments: IPWWorksheetNeeded if. <br />• <br />Sys Dev Eva ffi Trac Mit.� Eval <br />332� 5 i❑Site Work or Drainage Proposed <br /><❑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 />P{ See PW Review Worksheet and associated attached items <br />-A Separate PW Permit is Required (Permit #: PW ZW5 'oo C ) <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: 0,3 , <br />Qz� <br />