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Intake & Approval Sheet I&FOR PERMIT STAFF ONLY ft PERMIT # 3-Z704-02-6 <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/Addn/Rem Size <br />44�2 <br />Garage/Accessory Struct. Size <br />--- <br />Number of Stories <br />Basement <br />I&No LJYes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />u <br />Occupancy Load <br />Fire Sprinklers: []Update Existing ❑New System <br />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 />M No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes <br />O No <br />VALUATION CALCULATION: Total $ —A- 5'1l <br />itional Notes: <br />JApproved By: �� Date: .¢/ 1-,a[ Zo?r?� <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 />O\Review / Inspection Scope - ADD FIRE FEE <br />Approved By: _ L , 1 Date: _5 l 27 <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 R uired before Final? ❑Yes []No <br />"In Lieu" Fee: Type: Z Amount $ <br />School Impact Fee: Totai <br />Calculated: Credit: <br />[]Everett School D' ❑Mukilteo School Dist <br />Additional Note . <br />kpprov.P�Y. Date: 2 tat <br />PUBLIC WORFCS <br />Intake OK by: Date: <br />Intake Comments: DPW 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 />Esupportive housing) <br />t <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 />ff-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 />❑ WIII be issued separately (separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />r-1 216�-b I( <br />Approved By:— f1�'fa e: 2 j , oaa <br />