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Intake & Approval Sheet (FOR PERMIT STAFF ONLI) <br />PERMIT #�✓ ;? —Co�— <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 />l/jll ('4✓lv7 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />INNo ❑Yes , Fin / Unfin <br />Type of Construction <br />V <br />Occupancy Group <br />/n <br />Occupancy Load <br />1? <br />Fire Sprinklers: ❑Update Existing []New System EflNot Req'd <br />Reason Sprinklers Required: <br />nr�1�lv' <br />Fire Alarm: ❑Update Existing ❑New System t�ot 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 ®No <br />VALUATION CALCULATION; Total$ l.f— <br />Subject To Field In$pection <br />By The ROM 11W 60lbl <br />SI�+S pG��tc✓L <br />Additional Notes: �l(/� /s"7GrGyl/jL <br />Approved By: Date: �( <br />V <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 B . Date:'l 2 <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 />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <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.cL Jt Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Worksheet Needed If., <br />❑Sys Dev Eval ❑TrafFlc Mit Eva[ <br />❑Site Work or Drainage Proposed <br />❑Backf[ow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <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 vrith this folderfor 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: <br />St <br />