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Intake & Approval Sheet (FOR PERMIT STAFF ONLI9 <br />PERMIT #Z 2,koq --C ` C) <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 />If IY6 I,- <br />-Garage/Accessory Struct. Size <br />P /5-5 <br />Number of Stories <br />Basement <br />QNo ❑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? qYes ❑ No <br />VALUATION CALCULATION: Total <br />vex' Uca <br />-7 <br />A <br />Additional Notes: <br />Approved B : Date: s� <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 />19 Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: <br />Date: - Q <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING;,,, <br />Intake OK by: Assign To: Date: .Z <br />Intake Comments: <br />-01 h 0 (661CK M eA V14A IGti XIIA M2� area <br />el t o ! ►wl r� fi �� � � �1�'IILG-ti �t�► <br />❑ Attach to Project No.t�O'LI <br />❑ Route to Historic Reviewer <br />OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />- <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />S <br />Proposed No, of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? 91yes ❑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 />�co _ <br />Approved By: ILL Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />.....,..........,,..,..,.,,,,................... ,..,.............. ..... .............................................. <br />,.,, ,,...,..........,,,.,. <br />Intake Comments: 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 />t.......... <br />.................... ........... .................................. <br />... „ ,. ...... ,,,,, <br />El 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 Coin 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: �. <br />F�J <br />'J I 1�_Ik <br />