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• <br />Intake & Approval Sheet <br />(FOR PERMIT STAFFONL� • PERMIT# ��lb� JV[ I <br />BUILDING <br />Intake OK b Date:O� Z� Z07-/ <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI d ern Size <br />Garage/Accessory Struct. Size <br />3Zo 4 <br />Number of Stories <br />2 <br />Basement <br />MNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ErNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System 120Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 13No <br />Add'I RCW 64.55 dots required prior to final? ❑Yes Zo <br />VALUATION CALCULATION: Total $ 1 ZSS, oO O <br />2 5 fim WLy AfO V t -- taW <br />Additional Notes: <br />Approved By: Date: <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:ffia.-ADate: /24a, <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.Ag Date: <br />PUBLIC WORKS <br />Intake OK by:. Date: _ <br />Intake Comments: PW Worksheet Needed if. <br />❑Sys Dev Eva[ ❑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 />❑Route this folder for PW Review at end --- PW Review Worksheet-.-_w <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />191 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 />❑ 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: 0/8 1O <br />2/Z <br />