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Intake & Approval Sheet (FOR PERMIT STAFF ONLr 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 />'j IT:;? <br />Garage/Accessory Struct. Size <br />— <br />Number of Stories <br />4— <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction <br />y 1 <br />Occupancy Group <br />u <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ®Not Req'd <br />Reason. Sprinklers Required: <br />Fire Alarm: ❑ Update Existing ❑ New System M 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 ®No <br />VALUATION CALCULATION: Total $ ;22�-1 txp <br />Additional Notes: <br />Approved By: rlX7Date: Z-1 ag)'u <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 />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />A-uommoil4A41'**­- <br />OAttach to Project No. �e ) -L 21 — o <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />El Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Lj <br />Proposed No. of Dwelling Units: <br />�— <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes MO <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: 58,.�b� ^� r'yva4- <br />r <br />j���Z�C <br />1'rj Ce.( (ej mil V J Vic— V Ply <br />-Ll Foo-g' <br />Approved By: I Date: to. <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: 3PWWorksheet Needed if.• <br />3 <br />❑Sys Dev Eva] ❑Traffic Mit Eva] <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />3(dental, medical, animals, mortuary, hospital, <br />Isupportive housing) <br />❑Route this folder for PIN 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 />11 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 />Approve Date: <br />4- <br />