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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT #(3��2 �g l l 8 <br />BUILDING <br />Intake OK by: "K' Date: `O��✓�ZO�iZ <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 />(S"7 3 5F <br />Garage/Accessory Struct. Size <br />561 SF <br />Number of Stories <br />Basement <br />12No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing LpNew System ❑Not Req'd <br />Reason Sprinklers Required: lIAWHOP1115- .i2C l�313-► <br />Fire Alarm: ❑Update Existing ❑New System .RNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes UNo <br />VALUATION CALCULATION: Total $ 2,33e Io 1 <br />!S7 3 5r x ISOXW :=4 2Dy, 4 9a <br />S%I J* 2 8, rD t ► <br />�233,I�I <br />Additional Notes: SIW-,LlC— ' LDS <br />Approved By: Date: 10131202 L <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />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: Date: 4� ` <br />ELECTRICAL/PLUMBING <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 />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 3c/c <br />Calculated:y c Ic Credit: <br />Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By: _G- c Z� "L. Date: ._ Z 2 <br />PUBLIC WORKS <br />22 <br />Intake OK by: Date: � <br />.......... ................................................................... .w....... ....................................... ........... ........ _... <br />Intake Comments: PW Worksheet Needed if., <br />N.Sys Dev Eva] l Traffic Mit Eval <br />i <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />j(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 14Submitted Previously ❑Deferred <br />IN This Permit is Approved by Public Works <br />Q* 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 />9 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:W <br />AT Date: glM <br />1Z2_)__-, <br />