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Intake & Approval Sheet (FOR PERMIT STAFF ONL1q PERMIT # <br />BUILDING <br />Intake OK b Date: OA t eZ <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit z <br />Bldg/TI Ad /Rem Size <br />j J 4 - 2 367 DE5 k_ <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Z <br />Basement <br />[]No Yes , Fin / nfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System PNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes 12 No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes PQNo <br />VALUATION CALCULATION: Total $ 3 `l0jV 0 o <br />p <br />1 eL Aeuc <br />Additional Notes: <br />Approved By: , L_ Date: J211I,Z.-L <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers El 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: 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 />- <br />Overlay/Agreement <br />Residential Use <br />Proposed No. of Dwelling Units: <br />^ <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? <br />❑Yes Co <br />"In Lieu" Fee: Type: Amou <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />El Everett School Dist Mukilteo School Dist <br />Additional Notes: <br />Approved K Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: 'PW Worksheet Needed if: <br />El 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 />lsupportive 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 Coin with 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: <br />Approved By: <br />Date: <br />1 Y 1 <br />qz— <br />