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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) *PERMIT #5 ZOO — Of <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this "W" Permit <br />Bldg/TI/ n em Size <br />Garage/Accessory S ruct. Size <br />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />,rA <br />Occupancy Group <br />'14 '0 <br />Occupancy Load <br />Fire Sprinklers: PUpdate Existing El New System ❑Not Req'd <br />Reason Sprinkles Required: <br />Fire Alarm: Update Existing [I New System []Not 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 MNo <br />VALUATION CALCULATION: Total $ 00 <br />Additional Notes: <br />Approved , �j Date: 2& z- l i' <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />Lr]Fire Sprinklers 04+re 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/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 Jallo <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By: Date: L� <br />BLIC WORKS <br />Intake OK by: —V Date: U'' I z--� <br />..._........-.................. ......................... .._..... _................ ............................ ........... .._� ..., <br />Intake Comments: PW Worksheet Needed if: <br />f,l-L1�-+-c4.ci.e I❑Sys Dev Eval []Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />til o -P ors s <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />Esupportive 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 [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 (Join with this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />13FUblic Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: Date: <br />