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Intake & Approval Sheet -FOR PERMIT STAFF ONLY) PERMIT #�!)2-C � <br />pp r � �. <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/Tl/Addn/Rem Size <br />Garage/AccessoryStruct. Size <br />$ <br />, <br />Number of Stories <br />Basement <br />[ANo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System <br />Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes <br />14 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes <br />RNo <br />VALUATION CALCULATION: Total $ S Ia 12 <br />Additional Notes: <br />Approved By: Date: <br />ZO <br />FIRE_ DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />s, <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: `OIL16M Date: <br />Intake Comments: <br />a\ C&xk\a " <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />810K to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />- 1 <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 Fi ? ❑Yes []No <br />"in Lieu" Fee: Type: Am t $ <br />School Impact Fee: Total $ _ <br />Calculated: X: <br />❑Everett School Dist ukilteo School Dist <br />Additional Notes: <br />Approved B Date: <br />PUBLIC WORKS <br />Intake OK by:' fl to Date: t 4 2-0 <br />:..........................._...,,,..,.,.................. ,...,..................... .....,.......,,.....,.,,.... ....................... ,.... <br />Intake Comments: PW Worksheet Needed if.• <br />A�(�vu Su�RooM�- I(oq�)Sys Dev Eval ©Traffic Mit Eval <br />—PAD ❑Site Work or Drainage Proposed <br />-- —� ❑Backflow Prevention for high hazard: <br />Zp l sf (dental, medical, animals, mortuary, hospital, <br />" 'supportive housing) <br />,,;................. <br />......................... <br />9R'6ute 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 />is Permit is Approved by Public Works <br />e 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 folderforpermit issuance) <br />❑ Will 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: OZ Z� <br />