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Intake & Approval Sheet *FOR PERMIT STAFF ONLI0 * PERMIT #_B2J62,-0L_(P_ <br />BUILDING <br />Intake OK by: rA_ Date: <br />Intake Comments: <br />0 Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />b -T_T' <br />Garage/Accessory Struct. Size <br />-- <br />Number of Stories <br />�- <br />Basement <br />IDNo []Yes, Fin / Unfin <br />Type of Construction <br />IR.G <br />Occupancy Group <br />(R-C, <br />Occupancy Load <br />"— <br />Fire Sprinklers: ❑Update Existing ❑New System <br />®Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System <br />®Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes <br />91 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes <br />IM No <br />VALUATION CALCULATION: Total $ 6✓ 51 <br />3�1. 111 10 <br />g !Q <br />Additional Notes: <br />Approved By: Date: <br />( <br />eux)—\ <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 />❑ 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 1lo <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:\TW'�"-1 Date: Z Z <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Worksheet Needed if. <br />❑Sys Dev Eval []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 <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 />EY'A Separate PW Permit is Required (Permit #: PW Z10 Z <br />AND El Is located in this folder <br />Wis in a Separate Green Folder (join with this folder for permit issuance) <br />0 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 B Date: Ct S 20 Z{ <br />_YZ <br />