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Intake & Approval Sheet ! (FOR PERMIT STAFF ONLr PERMIT # Z 2003 - CA 0 <br />BUILDING <br />Intake OK by: Date: 3/4Z O <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: El Update Existing ❑New System []Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ED No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes 10No <br />VALUATION CALCULATION: Total $ 41 (0 <br />7P a .4a <br />2 z ce 3o <br />Additional Notes: 201, / i C <br />Approved By: OW Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers []FireAlarm ❑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 />Cc k s 0, <br />❑ Attach to Project No. <br />El 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 />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />-- <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? <br />❑Yes JDNo <br />"In Lieu" Fee: Type: Amoun <br />School Impact Fee: Total $ <br />Calculated: Cre <br />❑Everett School Dist ❑Mukilt School Dist <br />Additional Notes: <br />Approved By: Date: ?) <br />PUBLIC WORKS <br />Intake OK by: Date: l��3 <br />Intake Comments: ,/ PW Worksheet Needed if., <br />l/tlwk 0Sys Dev Eval []Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />r _0Backflow Prevention for high hazard: <br />-(dental, medical, animals, mortuary, hospital, <br />,supportive housing) <br />e....-.,........_.,............ ............_..._....._.............................................�......_.__......,...... <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: , ��Q <br />