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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />BUILDING <br />Intake OK by: Date:,^.,, -,_ <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residentlal Building <br />Q Make this a "W" Permit <br />Bldgf l/Addn/Rem Size <br />Q �" <br />Garage/AccessoryGarage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />ZNo ❑Yes Fin 1 Unfln <br />Type of Construction <br />Occupancy Group <br />ti <br />Occupancy Load <br />z. <br />FireSprinklers: ❑Update Existing New System ❑ Not Req'd <br />Reason Sprinklers Required: <br />New Alarm: ❑update Existing INNew S stern ❑Not Re -d <br />IN <br />Reason Fire Alarm Required: <br />AW 64.55 MF warksheet req'd for permit? Yes [I No <br />d'I RCW 64.55 docs requiredprior to rrnai? ❑Yes El No <br />VALUATION CALCULATION: Total $ QtVOI ZIR <br />11, b¢iiOt t 1 i t <br />Additional Notes: <br />Approved By: Date: to 777c .v <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />OFIre Sprinklers Ofire 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 />AL <br />/ Inspection Scope -ADD FIRE FEE <br />CET-Review <br />13 : Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PERMIT' <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />❑ Attach to Project No. _ <br />❑ Route to Historic Reviewer <br />d OI< to Route to Other Departments <br />❑ Hold In Planning File Drawer <br />Zone <br />R-4 <br />Overla (Agreement <br />N/A <br />Norresidential Use <br />Residential Use <br />YES <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />PlanninglLandscape Inspection Required before Final? R]Yes []No <br />"In Lieu" Fee: Type N.48 Amount $ <br />School Impact Fee: Total $ $10,836 <br />Calculated: 18units 4 , '— Credlt:80*$43,344 <br />SEverett School Dist ❑ Mukilteo School Dist <br />Additional Notes: Final TDDM regqu�iirred prior to C/O <br />AA <br />Approved By: a,- ;. _ Date: 1o•9.2020 <br />PUBLIC WORKS <br />Intake OK by: Date:___ _ <br />Intake Comments: PIN Worksheet Needed If., <br />[]Sys Dev Eval OTraffic MIt Eval <br />Qsile Work or Drainage Proposed <br />❑ Backfiow Prevention for high hazard: <br />(denloi, medical, animals, mortuary, hospltaf, <br />supportive housing) <br />❑Route this folder for PW Review at end PWReview Worksheet <br />[]This project also has a separate concurrent PW Review (Green Folder) <br />AND []Create Green Folder []Submitted Previously [Deferred <br />El;This Permit Is Approved by Public Works <br />a <br />RSee PW Review Worksheet and associated attached items <br />RA Separate PW Permit is Required (Permit ti: PW`2btyr}^"0C�t ) <br />AND ❑ Is located In this folder <br />ERIS In a Separate Green Folder Colnwiilithts folder forpermlttssuanca) <br />❑ Will be issued separately (separate Green Folder, PW issued ahesdolSidg) <br />❑ Public Works has no scope •— PW Not Required <br />Additional Notes; <br />i.'r't�' '�1; �A.l;�l� f' �,>L� fal'�ti'.�.� {y( ��`�•� f`�/��t"rll'� <br />Approved By: Date: <br />