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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # DIV -7_ 651 <br />BUILDING <br />Intake OK by: Date: %B/,VZPOZ <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 />Garage/Accessory Struct. Size <br />57 j -7 SF <br />Number of Stories <br />�J <br />Basement <br />EQNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />jec- <br />Occupancy Load <br />S41c, <br />Fire Sprinklers: El Update Existing 10New System ❑Not Req'd <br />Reason Sprinklers Required: y09+6 a13. <br />Fire Alarm: []Update Existing []New System LQNot Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes rii�No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ®No <br />VALUATION CALCULATION: Total $ ZI,S, I0-7 <br />I4L4 Ll 51F xf13o/SF--0187/ 7 2c-> <br />5 3-7 S-F X 0 51 /SF -r 1$ 2 7/ 9 9 7 <br />2 Is, i 07 <br />Additional Notes: <br />Approved By: -r. Date: /411-417-t�2Z <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 />aReview / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: _ <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 $ 7p/0 <br />Calc ted: - o/ Credit: <br />Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: �� / i r.GL�. ► ✓,1� •J ./ Z <br />Approved By: _ G`�"—'-6ate: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />.................. ..,,.,,.,,.....,................... .............. ........................................... ................_ ._..__... <br />Intake Comments: PW Worksheet Needed if. • <br />❑Sys Dev Eval Traffic Mit Eval <br />I []Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />i(dental, medical, animals, mortuary, hospital, <br />Isupportive housing) <br />....................................................................................................................................................... <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 NSubmitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />19 See PW Review Worksheet and associated attached items <br />® A Separate PW Permit is Required (Permit #: PW-7r, p2 <br />AND ❑ Is located in this folder <br />0 Is in a Separate Green Folder Coin 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 />77 <br />Approved By: Date: <br />a <br />