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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT #
<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 />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 ❑Not Req'd
<br />Reason Sprinklers Required:'
<br />Fire Alarm: ❑Update 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 IM No
<br />VALUATION CALCULATION: Total $
<br />Additional Notes: Vd)ot� RF-PI A�L���1�tS R s�2
<br />Approved By: Date: g ,2�lZ
<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 />❑ Review / Inspection Scope - ADD FIRE FEE
<br />Approved By: Date:
<br />ELECT CAL
<br />Additional Notes:
<br />Approved By: Date:
<br />PLANNING
<br />Intake OK by: Assign To:Date:?i
<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 />&t (v
<br />Nonresidential Use
<br />Pup
<br />Residential Use
<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: Credit:
<br />❑Everett School Dist ❑Mukilteo School Dist
<br />Additional Notes:
<br />Approved By: Date: , / 3 .
<br />PUBLIC WORKS
<br />Intake OK by: Date:
<br />.....................................................................................,..,,,,,,.,,,,.,,,..,..,.,.,,,,,.,,,,,,,,,,,,;,,,,,,,,,,,.,,,.........
<br />Intake Comments: IPW Worksheet Needed if:
<br />3
<br />0Sys Dev Eval ❑Traffic Mit Eva[
<br />❑Site Work or Drainage Proposed
<br />❑Backflow Prevention for high hazard:
<br />((dental, medical, animals, mortuary, hospital,
<br />`supportive housing)
<br />.................................................................................................
<br />..................Y......
<br />.............
<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 />❑ 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 />s-rAfepCKG V-4c=NT- OF- wA-e .
<br />2 /Z 21 Z4
<br />Approved By: Date:
<br />
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