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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT # F22a2 <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 />19., SZ� 4*�'- <br />Garage/Accessory Struct. Size <br />— <br />Number of Stories <br />4- <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction <br />" A <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: dUpdate Existing ❑New System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: IM 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 E]No <br />VALUATION CALCULATION: Totals ano <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers . Ire 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: VjYDate:2� <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 <br />XF6 <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: �Jh�U ter 1C.J C' I A-12 <br />V14 <br />Approved By: <br />Date: <br />IZTUBLIC <br />WbRKS--' <br />Intake OK by: _Date: <br />Intake Comments: PW Worksheet Needed If., <br />[]Sys Dev Eval ElTraffic'Mit Eval <br />'[]Site Work or Drainage Proposed <br />iElBackfiow <br />Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />supportive housing) <br />❑ Route this folder for PW Review atend--- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously El 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 Z 2a 5 -a ( V) <br />AND 10 Is located in this folder <br />❑ Is in a Separate Green Folder aoln urith 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 ByA&lyDate: 9 1 O <br />.M <br />z6 <br />