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Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT # 4t-3©� <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 />le. <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Z <br />Basement <br />,R]No ❑Yes , Fin / Unfin <br />Type of Construction <br />1 <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ❑Not 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 ® No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ® No <br />VALUATION CALCULATION: Total $ ZO <br />Additional Notes: 2 r01 S /P—C wng. <br />Approved By: Date: qxg Z® <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 />❑ 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 />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Not <br />�- G 42,230 <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: IPWWorksheet Needed if. <br />• <br />I []Sys Dev Eval ❑Traffic Mit Eval <br />I[]Site Work or Drainage Proposed <br />❑Backfiow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />I'suppordve 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 <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folderfor permit Issuance) <br />0 WIII be issued separately (separate Green Folder, PW issued ahead of Bldg) <br />tblic Works has no scope --- PW Not Required <br />Additional Note 65/-,.a 24 <br />Approved By: Date: <br />41- <br />