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Intake & Approval Sheet (FOR PERMIT STAFF ONLI <br />PERMIT # 8 2I ®6 —oO-- <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 />C <br />Garage/Accessory Struct. Size <br />—" <br />Number of Stories <br />% <br />Basement <br />MNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Q <br />Fire Sprinklers: M Update Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: OUpdate Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes E No <br />VALUATION CALCULATION: Total $ JO7, 000 <br />Additional Notes: <br />Approved By: f Date: c (� <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />.H . <br />Additional Notes: , <br />Fire Dept. Fees: <br />❑ Review s-Built Plans - NO FIRE FEE <br />V❑ mal or No Fire Scope - NO FIRE FEE <br />Review / Inspection Scope- ADD FIRE FEE <br />Approved By: e: �o �5- <br />TRICAL <br />Additional Not <br />Approved By: Date: <br />PLANNING <br />Intake OK b 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 />\O <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 Required befor nal? <br />❑Yes ®No <br />"In Lieu" Fee: Type: mount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist Mukilteo School Dist <br />Additional Notes: <br />Approved Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />.-...-... .... .................. ........ ,.-...................... _.....- ...... <br />.,, ....,_.....,.,-, .__ <br />Intake Comments: PW Worksheet Needed if: <br />`171 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 />......... ........ .._.... �.__._.. <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 (Join with this folder for permit issuance) <br />❑ WIII be Issued separately (separate Green Folder, PW issued ahead of Bldg) <br />R-Public Works has no scope --- PW Not Required <br />Additional Note o "7 / Is ZI <br />Approved By: Date: <br />M <br />2-1 <br />