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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑dRoute to Residential Building <br />to Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />2. <br />Basement <br />❑No MYes in nfin <br />Type of Construction <br />Occupancy Group <br />R <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes M No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ONo <br />VALUATION CALCULATION: Total $ 37 Sow <br />(J�fFliu. !a'�ryvr 87S" S.d� <br />Additional Notes: Z(5l6- <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El 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 Sc pe -ADD FIRE FEE <br />Approved By: ,cam Date: ?% fi <br />LECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date: <br />Intake Comments: Assign To: <br />❑ Attach to Project No. <br />El Route to Historic Reviewer <br />Ea/ol< to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />— 5 <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />L)u <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? <br />❑Yes ENO <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ 24tid 04 <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved B Date: <br />9 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />•-------------- -------------------------- <br />Intake Comments: ; PW Worksheet Needed if., <br />[]Sys Dev Eva ❑Traffic Mit Eval <br />[]Site Work or Drainage Proposed <br />❑Backflow 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 Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items in <br />�dA Separate PW Permit is Required --(P/ermit #: PW Pf <br />AND 14 Is located in this folder�or7�n�c jxeM#J�'l <br />❑ Is in a Separate Green Folder Qoin vrith this folder for permit issuance) <br />❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: SM16aahj& REVIQ) s FiET <br />W 091419?K— P&&n2 AhW E < f4e_ V TW7r,& 7a <br />�,,em»'F&mi of movffw Fiemin. <br />Approved By: Date: 7 g Zp/ <br />Ma <br />