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`Intake & Approval Sheet <br />10 (FOR PERMIT STAFF ONLY) 0 <br />PERMIT # <br />0 20 0 -1 _00-1 <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />0 Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a -W" Permit <br />Bldg/TI/Addn/Rem Size <br />251 a44 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />No ElYes, Fin Unfin <br />Type of Construction <br />V <br />Occupancy Group <br />I? <br />Occupancy Load <br />IL95 <br />Fire Sprinklers: OUpdate Existing WNew System ONot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: OUpdate Existing;) New System ONot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? X]Yes ❑ No <br />Add'I RCW 64.55 does required priorto final? 0Yes WNo <br />VALUATION CALCULATION: Total $ VP <br />;23l 544- <br />Additional Notes: <br />IlApproved By: Date: J C>/ v!;,120 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />�re Sprinklers DRFire Alarm 0Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />11 Review of As -Built Plans - NO FIRE FEE <br />0 Minimal or No Fire Scope - NO FIRE FEE <br />IfikReview / Inspection Scope - ADD FIRE FEE <br />Approved By:k Vg7k,)n Date: _ <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />IJ 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 />ON 1PW 'A <br />Planning/Landscape Inspection Required before Final? ElYes 0No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />DEverett School Dist 0Mukilteo School Dist <br />Additional Notes: <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Worksheet Needed if., <br />[3Sys Dev Eval OTraffic Mit Eva] <br />0Site Work or Drainage Proposed <br />1313ackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />supportive housing) <br />ORoute this folder for PW Review at end --- PW Review Worksheet <br />OThis project also has a separate concurrent PW Review (Green Folder) <br />AND ElCreate Green Folder OSubmitted Previously ODeferred <br />This Permit is Approved by Public Works <br />tZSee PW Review Worksheet and associated attached items <br />fKA Separate PW Permit is Required (Permit #: PW;200f:700-4-) <br />AND 11 Is located in this folder <br />Rls in a Separate Green Folder (join with this folder for permit issuance) <br />1:1 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: <br />