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Intake & Approval Sheet 9 (FOR PERMIT STAFF ON09 6 PERMIT # W 04' 0000 <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 d em ize <br />(o <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />WNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group , <br />(A <br />Occupancy Load <br />Fire Sprinklers: []Update Existing ❑New System El 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 91 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ANo <br />VALUATION CALCULATION: Total $ ` -10 F35`l <br />/21 <br />j2 ��1trx�S� /97- 2 S (-- ? / <br />G-4�q 2 (ef e IS <br />Additional Notes: 2—oIS !ttL �, <br />Approved By: Date: —721-111 <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 />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK b Date: <br />Intake Comments: Assign To: <br />❑ Attach to Project No. <br />❑ Ro o Historic Reviewer <br />12 QKto, Route <br />to Other Departments <br />Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />�— <br />Nonresidential Use <br />Residential Use <br />t%jZ <br />Proposed No. of Dwelling Units: <br />�— <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: "f JVW <br />�� <br />OWN if <br />Approved Date: 1 8 <br />PUBLIC WORKS <br />Intake OK by: ), Date: "-[ W19 <br />--- ---- - - -- - ------------ -------- <br />Intake Comments: ; PW Worksheet Needed if., <br />7"0 an <br />rro 5 it %Z- : ❑Sys Dev Eval ❑Traffic Mit Eval <br />[]Site Work or Drainage Proposed +a o <br />�N�-Ca1..-i Etf� Sz•. rro�Pfi,�t.. P <br />(/ L-, ����,�«a,,,,������,� ❑Backfiow Prevention for high hazard: <br />(.0 ; r£:(,tl�i � '(dental, medical, animals, mortuary, hospital, <br />Q GI►►Lhllf6l�tcM«'�/FFF�,' 11VV_ �jp � �portive housing) <br />a" •'_-= ------------------------------------ <br />oute 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 />lPublic Works has no scope --- PW Not Required <br />AOditional Notes: <br />Approved By: Date: 61 0 <br />