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Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT # 22,02- 0 <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" ermit <br />Bldg/TI/Ad em Si <br />Z— <br />Garage/Accessory Struct. Size <br />R10 <br />Number of Stories <br />Z— <br />Basement <br />❑No RLeCQUnfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System PKot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System.-Qvot Req'd <br />I'' <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes [N No <br />Add] RCW 64.55 docs required prior to final? ❑Yes No <br />VALUATION CALCULATION: Total $ UGr7. 0Q <br />Additional Notes: <br />Approved B Date: 7c �z- <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sp ' klers ❑F e Alarm ❑Other: <br />Additional Not : <br />Fire Dept. Fees: <br />❑ Review of As-Bui Pla - NO FIRE FEE <br />❑ Minimal or No Fir Scope - NO FIRE FEE <br />❑ Review / Inspecti n Scope - ADD FIRE FEE <br />Approved By: Date: <br />'ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />L <br />Intake OK by: rI Assign To: Date: �✓J&1 <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 Required before Final? ❑Yes 1XN0 <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 />Approved By: Date: <br />rya <br />UBLIC WORKS <br />I e OK by:. Date: _ <br />In e Comme�njt�s:� =pW Worksheef Needed if. <br />r�TTt�' PV41lL'i%,I I❑Sys Dev Eval ❑Traffic Mit Eval <br />( d I❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />_(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />El Route this folder for PW Review at end -- PW Review Worksheets <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 Qoin with this folder for permit issuance) <br />❑ Will be Issued separately (separate Green Folder, PW issued ahead of Bldg) <br />�ublic Works has no scope --- PW Not Required <br />Additional Notes: <br />�� (0 3 I Zc>2z <br />Approved By: Date: <br />0 <br />