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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT # ^'� O ` '_ 02F� <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />ake this a "W" Permit <br />Idg/T /Addn/Rem Size <br />Q a 5 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />nNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Z71Le' <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System pl�ot Req'd <br />Reason Sprinklers Required: <br />ML <br />Fire Alarm: ❑Update Existing ❑New System of 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 o <br />VALUATION CALCULATION: Total $� <br />q8l/ rxzsyst;� z:/3,1/)v <br />Additional Notes:=NC%--L4OE OWNEV- TW <br />Pr %-t- vf''t01L.S . <br />Approved B 1 Date: 71 dz ` <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: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by Assign To: (W1- Date: <br />Intake Comments: <br />5t, ic- PW (1 �Ini'ari -i XrJAU,0+ Of <br />J <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />K to Route to Other Departments <br />,�c.., <br />dHold <br />in Planning File Drawer <br />Zone <br />0Y, <br />Overlay/Agreement <br />f�,S-tS(C: 6k)�6 <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 $ <br />Calculated: Credit: <br />El Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By: Date: ni <br />PUBLIC WORKS <br />Intake OK by: Date: <br />............................................................................................................ <br />Intake Comments: 1 PW Worksheet Needed if: <br />❑Sys Dev Eval ❑Traffic Mit Eva] <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />supportive housing) <br />..... ............. <br />................... <br />.. ... ............. .............. <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 ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />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 />❑ Is in a Separate Green Folder (loin 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: \ li. Date: <br />1�y <br />_�dd " Y s� r f 2J) zl <br />