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Intake & Approval Sheet <br />t PERMIT STAFF ONLY} :;IMIT #. <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 />L 3 <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 ❑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 priortofinal? ❑Yes ❑No <br />VALUATION CALCULATION: Totals o-?,3' q <br />�3 <br />Additional Notes: <br />Approved By: Date: 6( <br />FIRE DEPARTMENT <br />Separate I 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 />19 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 />' 2 <br />Overlay/Agreement <br />Nonresidential Use , <br />Residential Use <br />G <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 Notes: No Q0.& Ve215. <br />No conShrVGhec� OVU- excSJ-n <br />�d - �.*r• Jv.C'.. LI2" 0A)aV - rade.�w <br />Approved By: Date: /0-5--Z02 <br />PUBLIC W®RKS°` <br />Intake Eby: Date:,.......... 1 4 28 <br />• <br />Intake Comments: IAl WIN Worksheet Needed if. <br />Qi(d) l}C.I( IW hn I f 1]Sys Dev Eval ❑Trafftc'Mit Eval <br />Ii.I'00d �Dr�f �1]Site Work or Drainage Proposed <br />T <br />A;l <br />❑Sackflow for high hazard: <br />l : Prevention <br />'(dental, medical, animals, mortuary, hospital, <br />esupporfive 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 ❑Referred <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 folderfor permit issuance) <br />❑ Will 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:0YWV1AA <br />Date: b d <br />U Jf <br />