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0 <br />intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT #✓ <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 />Btdg/'fi/Addn/Rem Size <br />180 83a `0 <br />Garage/AccessoryGarage/Accessory Struct, Size <br />.w <br />Number of Stories <br />Basement <br />W No ❑Yes Fin / Unfln <br />Type of Construction <br />Occupancy GroupQ—eZ <br />Occupancy Load <br />CIS <br />Fire Sprinklers: El Update Existing rX News stem ❑Nat Req'd <br />Reason Sprinklers Required'. <br />Fire Alarm: ❑ Update >:xlsting El New System ❑ Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? Yes ❑ No <br />Add'IRCW 64.55docs requlred priorto final? ❑Yes MNo <br />VALUATION CALCULATION: Total $ 02 o 4 O 3 £r Z <br />N 011i <br />Additional Notes: <br />Approved By: `- Date: j b 13 g'0 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />p�ue Sprinklers Ire Alarm []Other: <br />— <br />Additional Notes: ? <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />0 Minimal or No Fire Scope - NO FIRE FEE <br />Review/Inspection Scope- ADD FIRE FEE <br />Approved By.k 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 />a -a <br />Overlay/Agreement <br />N/A <br />Nonresidential Use <br />Residential Use <br />YES <br />Proposed No, of Dwellin Units:Ok <br />Total No. of Dwellin Units: <br />Plannin /Landsca a Inspection Required before Final? Yes ❑No <br />"In Lieu" Fee: Type: NIA Amount <br />School Impact Fee: Total $13,846 <br />Calculated: 23 @ $3,010 Credit: 80%, $55,384 <br />DEverett School Dist ❑Mukiiteo School Dist <br />Additional Notes: Final TDM required prior to C/O <br />Approved By: Date: 10.9.2020 <br />e, <br />PUBLIC WORKS <br />Intake OK by: Date: _ <br />Intake Comments: PW Worksheet Needed if: <br />©Sys Dev Eval OTraffic Mit Eval <br />[3Site Work or Drainage Proposed <br />❑Backilow 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 Foldar) <br />AND Elcreate Green Folder ❑Submitted Previously ❑Deferred <br />G(Thls Permit is Approved by Public Works 0� <br />®,See PW Review Worksheet and associated attached Items <br />Z.A Separate PW Permit is Required (Permit #: PW'2' -' U 0ti ) <br />AND ❑ Is located in this folder <br />tvFf <br />M Is In a Separate Green Folder Coln with this folder for permit Issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW Issued ahead of Bidg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: 1 <br />G� <br />Approved By: = Date: <br />'14 <br />