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Intake & Approval Sheet 110 (FOR PERMIT STAFF ONLY) o PERMIT # 2X2,- C)2 .1 <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 />Bldg/TI/Addn/Rem Size <br />44-11- <br />Garage/Accessory Struct. Size <br />— <br />Number of Stories <br />Basement <br />No ❑Yes , Fin / Unfin <br />Type of Construction <br />- P✓ <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd <br />Reason Sprinkl rs Required: <br />Fire Alarm: 0 Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? []Yes No <br />Addl RCW 64.55 does required prior to final? ❑Yes P No <br />VALUATION CALCULATION: Total $ J!J �• <br />Additional Notes: <br />Approved By: <br />Date: <br />FIRE DEPARTMENT - <br />Separate / Deferred Su <br />❑Fire. Sprinklers []FireAlarm ❑Other: <br />.4 . <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 />- <br />Overlay/Agreement <br />Nonresidential Use <br />` <br />\ <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: 2 1� 2�Zd <br />PUBLIC WORKS <br />Intake OK by: Date: 2-14 " 2© <br />...,..........-...-...._.M....._.......................... ___.......................................� <br />Intake Comments: PW Worksheet Needed if.• <br />��, N L1 1 r.1 SJLF4T0 �t l ❑Sys Dev Eval ❑Traffic Mit Eval <br />20Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />i(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 />❑ 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 />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />blic Works has no sco --- PW Not R quired <br />Additional Note <br />[Approved By: Date: <br />