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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) <br />(Zet.t.Eo 4L-"5 <br />PERMIT# 62-1(2-"'615' <br />BUILDING <br />1 <br />Intake OK by: Date: v , <br />Intake Comments: <br />rr Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />j 5 <br />Garage/Accessory Struct. Size <br />locpq <br />Number of Stories <br />�- <br />Basement <br />El No 91Yes , ni / Unfin <br />Type of Const9d8tion <br />Occupanc roup <br />-rn <br />�s�1� L <br />Occup cy Load <br />Fire rinklers: ❑Update Existing ❑New System!Q Not Req'd <br />Re son Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System Not Req'd <br />Reason Fire Alarm Required: <br />��11 <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 91 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ONo <br />VALUATION CALCULATION: Total $ 5101 90 <br />3 51$ 5F x 1301 i5r- {-i S?� 340 <br />s �o, ecto , <br />Additional Notes: <br />Approved By: Date: ZOZZ <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Require-': <br />El Fire Sprinklers ❑Fire Alar Other: <br />Additional Notes: <br />Fire Dept. Fe <br />❑ Rev! of As -Built Plans - NO FIRE FEE <br />Inimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope -ADD FIRE FEE <br />Approved By: K Date: 1- _ <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING. <br />Intake OK by: Assign To: <br />Date: <br />Intake Comments: <br />Attach to Project No. S SJI'00 <br />or1AInA <br />DD W00 <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 />C) <br />Planning/Landsca nspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: e: <br />Amount $ <br />School I act Fee: Total $ <br />Cal ated: Credit: <br />�— <br />Everett School Dist >Kmukilteo School <br />Dist <br />Additional Notes: <br />Approved B . <br />Date: <br />PUBLIC WORK$-` <br />Intake OK by: Date: <br />...............-. ....... ........... ..,..,........ .......... .... ......... <br />.,............................................... <br />Intake Comments: PW Worksheet Needed if, <br />❑Sys Dev Eval ❑Traffic'Mit Eval <br />Mite Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />1_ (j (dental, medical, animals, mortuary, hospital, <br />�Y V� supportive housing) <br />❑Route this folder for PW Review at end --- PW Review Worksheef <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 Wor <br />%See PW Review Worksheet associated attached items <br />A Separate PW Permi Required (Permit #: PW <br />AND ❑ Is located ' this folder <br />Is in eparate Green Folder (join with this folder for permit Issuance) <br />❑ WI 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 Date: <br />v <br />