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Intake & Approval Sheet <br />• (FOR PERMIT STAFF ONLr • PERMIT # v W l "�P <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 />Bldg/TI/Addn/Rem Size <br />crt,4 4-�2 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />�1 <br />Basement <br />[]No ❑Yes , Fin / Unfin <br />Type of Construction <br />V - 'A <br />Occupancy Group <br />R- 02 E 1 <br />Occupancy Load <br />oc) <br />Fire Sprinklers: ❑Update Existing New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing 5QNew System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? 99Yes ❑ No <br />Add] RCW 64.55 docs required prior to final? ❑Yes E3 No <br />VALUATION CALCULATION: Total $_ 4)'9-'$_ <br />c1$d-I b <br />r3 0(00 <br />3 3 eK.0 <br />S(c 1 °✓ 1 � 8 S 3 -50 <br />Additional Notes: <br />Approved By: Date: (O ,3 aoaD <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />Fire Sprinklers Bfire 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 />RReview / 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 />PON PW P <br />Planning/Landscape Inspection Required before Final? 12Yes []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: -mom <br />— ^`r Afr,wrj k %d/q LOW <br />[Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />._ ... .......... ........._..........._..__._...._....... _........ _.....-....,_....... ................... <br />_... <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 />. <br />........ ....... -._........................ -.......... _.._._..._..... .................._......_ <br />El 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 />J25L A Separate PW Permit is Required (Permit #: PW aL —Co ) <br />AND ❑ Is located in this folder <br />1A Is in a Separate Green Folder Qoin 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 />,­tv .{-o Pw a� Body P�.timf�s� <br />Approved By: Date: 3 <br />