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• <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />• PERMIT OC ZJCO 4 ` O l <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-g-I- <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑ No Yes , Fin <br />Unfin <br />Type of Construction <br />- <br />Occupancy Grou- <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 />21 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes <br />®No <br />VALUATION CALCULATION: Total $ Lvl 4(p-8 <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />FS�eparate 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 />❑ 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: Date: <br />Intake Comments: <br />❑ Attach to Project No. <br />N Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />- 2 <br />Overlay/Agreement <br />U►C <br />C��� S� <br />Nonresidential Use <br />Residential Use <br />JYW <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: edit: <br />❑ Everett School Dist eukilteo School Dist <br />Additional Notes: <br />Approved B Date: V- _ell2(� <br />PUBLIC WORKS <br />FIntakeby:Date: _ ___ntae omments: 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 />..........,......,,.,.....,.....................,.......,...,...........,..............,..,.............,.....................,...,....... <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 />5�A Separate PW Permit is Required (Permit #: PW 2-04' ° 4'0 ) <br />AND MIS located in this folder h 0 q rk" �* �6itr <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 />Approved By: Date: iZ <br />