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Intake & Approval Sheet (FOR PERMIT STAFF ONLr PERMIT # R2A y!� —01a <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 />Bld /TI/ ddn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />[]No ❑Yes , Fin / Unfin <br />Type of Construction <br />—,,11� <br />Occupancy Group <br />�t 3 <br />Occupancy Load <br />7367 72, <br />Fire Sprinklers: PUpdate Existing ❑New System ❑Not Req'd <br />Reason Sprinkler 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 S No <br />Add'I RCW 64.55 does required prior to final? ❑Yes ZNo <br />VALUATION CALCULATION: Total $� OnO, �' <br />Additional Notes: <br />Approved By:_k Date-/© d! ZpZ1 <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 />r <br />Review / Inspection Scope - ADD FIRE FEE <br />proved By: y 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 bef re Final? ❑Yes o <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: V NVjA Date: . IA. <br />M <br />PUBLIC WORKS <br />Intake OK by:. Date: <br />Intake Comments: PW Worksheet Needed if: _....... <br />❑Sys Dev Eval ❑Traffic Mit Eval <br />❑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 />❑ 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 />JA.Rublic Works has no scope --- PW Not Required <br />Additional Notes: / <br />Approved By: Date: <br />