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10FOR p 0066__Do�rj. <br />Intake & Approval Sheet PERMIT STAFF ONLY) PERMIT # 1/1 <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a :UVLEermit <br />Bldg/TI/Add /Rem Size <br />Garage/Accessory Struct.. Size <br />Number of Stories <br />Basement <br />❑No Ye , Fin Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />!� <br />Fire Sprinklers: ❑ Update Existing ❑ New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System grNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 171No, <br />Add'I RCW 64.55 docs required prior to final? ❑Yes o <br />VALUATION CALCULATION: Total <br />Additional Notes: <br />Approved By: Z_1a32P_ Date. <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El 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: 116 CotAPn 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 />— <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />b 2 <br />Planning/Landscape Inspection Required before Final? ❑Yes MNo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total <br />Calculated: Credit: 4\IQ <br />IN Everett School Dist ❑ Mukilteo School Dist <br />Additional Notes: <br />Approved By Date: , \ ��2 <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 />If -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 />❑ 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 />Approved By: Date: d <br />