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r _I <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # -( O(P —bl <br />BUILDING <br />Intake OK kL _ 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 />ar ccesso S e <br />Number of Stories <br />((o �— <br />'Z <br />Basement <br />No ❑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 />r� <br />Fire Alarm: ❑Update Existing ❑New System 19yyNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes <br />tt;;��,,No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes 21�� <br />0 <br />VALUATION CALCULATION: Total $ f 5�, 000 <br />Attu © v 6-IP- Z CA-e- C- WZI-W, e <br />Additional Notes: <br />Approved By: _ Date: D 0 ZtrZ <br />FIRE DEPARTMENT <br />eparate / 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 FEE13-MI <br />inimal or No Fire Scope - NO FIRE FEE <br />Q Review / Inspection Scope - ADD FIRE FEE <br />Approved By: —0 C, `✓TN Date: i <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />4tach 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 />rj <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />I AV <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 ist <br />Additional Notes: <br />Approved By: 4 AQA J Date: iU Z Z <br />4AJBLIC WORKS <br />Intake OK by: Date: <br />............................................................. ..........,,....................,............. <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 />. I'll........ .... .. . ,. <br />❑Route this folder for PW Review at end --- PW Review Wo1.rksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />N ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />I <br />TT Permit is Approved by Public Works PW Review Worksheet and associated attached items `7 <br />SVs, <br />ate PW Permit is Required (Permit #: PwZ! --U / ) <br />AND 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 />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: ^ Date: <br />4 <br />