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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT # W�20. - o G t
<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 />Bld 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 TrNot Req'd
<br />Reason Sprinklers Required:
<br />Fire Alarm: ❑Update Existing ❑New System of 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 o
<br />VALUATION CALCULATION: Total $ 6';6 Coo. D�
<br />Additional Notes:
<br />!Approved B Date: /L 1t.17h7
<br />FIRE DEPARTMENT
<br />Separate / Deferred Submittals Required:
<br />❑ Fire Sprinklers ❑ Fire Alarm ROther:
<br />Additional Notes: /C/o jz_010�
<br />Fire Dept. Fees:
<br />❑ Review of As -Built Plans - NO FIRE FEE
<br />❑ Minimal or No Fire Scope - NO FIRE FEE
<br />❑ Review / I s ection Scope - ADD FIRE FEE
<br />Approved B�z
<br />/ Date)
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<br />ELECTRICAL/PLUMBING
<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 r� �"►5
<br />Approved By: Date: , 2 3 •7 'Z
<br />UBLIC WORKS
<br />Intake OK by: Date:
<br />........................ ..._.................................. .................... .._..........................................................................
<br />Intake Comments: PW Worksheet Needed if.
<br />j []Sys Dev Eval ❑Traffic Mit Eval
<br />t ❑Site Work or Drainage Proposed
<br />(❑Backflow Prevention for high hazard:
<br />(dental, medical, animals, mortuary, hospital,
<br />........suppor.tive ,..,,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 (ioin 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: S,£_
<br />C' /4 z�
<br />Approved By:-_ Date:
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