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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # '163a * —Q' I <br />BUILDING <br />Intake OK by: Date: <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 />Number of Stories <br />Basement <br />❑No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System Mot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br />Add1 RCW 64.55 does required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $ IT& DGO, 00 <br />Additional Notes: <br />Approved B ,. Date: /�( <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: Date: <br />Intake Comments: <br />�;,Qrw,l !�► si�i v Gt,r�y bv�fi' nofi Ci � -� ba � <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 $ <br />Calculated: Credit: <br />El Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By: <br />Date: J ; <br />r— <br />PUBLIC WORKS <br />Intake OK by:. Date: <br />Intake Comments: .PW Worksheet Needed if: <br />' j]Sys Dev Eval El Traffic Mit Eva] <br />�PYJ� P (Site Work or Drainage Proposed <br />l�Backflow Prevention for high hazard: <br />l(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 />�y❑t See PW Review Worksheet and associated attached items <br />4p A Separate PW Permit is Required (Permit #: PW 2201b.0 �5 ) <br />AND RIs 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: Date: 19� Z� <br />