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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) 6 PERMIT # N U" I' <br />BUILDING <br />Intake OK by: Date: <br />Intake Commen : <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />BIdg/TI/Addn/Rem Size <br />gp �{-¢ <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />[]No 14Yes, Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System D9 Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: El Update Existing ❑New System [71Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 14 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ®No <br />VALUATION CALCULATION: Total $ is pe;o <br />Additional Notes: <br />Approved By: Date: 4- 9-4 ZOZO <br />M <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 S pe - ADD FIRE FEE <br />Approved By: Date: /o / <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: A • Z' ., <br />Intake Comments:�— <br />ex� "ate <br />❑ Attach to Project No. <br />Route to Historic Reviewer <br />ROK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />` <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 E[03N]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 />ceCpwiew'-C s�-' <br />Approved Bw:kk Date:, <br />PUBLIC WORKS <br />Intake OK by: -_r*A Date: CP 2_ 1 9 <br />................ ............... ,..........._.._...........,.,................. ................._......... _.......... <br />Intake Comments: =PIN Worksheet Needed if., <br />11Sys Dev EvaI []Traffic Mit Eval <br />=OSite Work or Drainage Proposed <br />=1113ackflow Prevention for high hazard: <br />_(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />a...._.__._..._........._.._�_.... W._.__...,__...........................__._...._._......... <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 Coin with this folderfor permit issuance) <br />❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />ItPublic Works has no scope --- PW Not Required <br />Additional Notes: <br />9 Z'9 20 ►9 <br />Approved By: Date: <br />1�_ <br />