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Intake & Approval Sheet db (FOR PERMIT STAFF ONLY) a PERMIT #_ SA A0?-' 0Oi <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 />Bidg/Ti/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <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 />❑ No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes <br />❑ No <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: Date: to <br />yam_ <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers El 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 />❑ 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: -Jess Date: Z <br />Intake Comm t : <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 />N/A <br />Nonresidential Use . <br />FOOd BeveM a establislnMCV* <br />Residential Use <br />M/A <br />Proposed No. of Dwelling Units: <br />JQA► <br />Total No. of Dwelling Units: <br />N A <br />PlanninglLands-cape Inspection Required before Final? ❑Yes IRNo <br />"in Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes:Meeded �o conq'.r-w, e;6si-eynce & legallIJ <br />oar 46e. QreZxis}tn9 Freesfandi" Sign ... it's }here <br />Approved By: Date: ! Q 0 7 Z Z <br />13UBLiC WORKS <br />Intake OK by: Date: 0 1 <br />a e Comments: DPW Worksheet Needed if.• - - �� ""-�......... <br />I❑Sys Dev Eval ❑Trafl•ic'Mit Eval <br />Wvn t ❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />------------ <br />supportive housing) ....-..........._.._...._......._ ...... ..... _...... ...... <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 />❑ 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: Zo Z t <br />