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Intake & Approval Sheet fFOR PERMIT STAFF ONLY �� PERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />14 <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />71 <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 El 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 does required prior to final? []Yes ❑ No <br />VALUATION CALCULATION: Total $ yp0 00ae DU <br />Additional Notes: <br />Approved B . Date: 09 Z' <br />FIRE DEPARTMENT <br />Separate I Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: 442, <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 13 Date:0 Z <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 />5 <br />Nonresidential Use <br />jr�.ii <br />Residential Use <br />Proposed No, of Dwelling Units: <br />Total No. of Dwelling Units: <br />4. <br />PlanningiLandscape Inspection Required beforeFinal? ❑Yes 91No <br />"In Lieu" Fee: Type: Am nt $ <br />School Impact Fee: Total $ <br />Calculated: Cre2ch6ol <br />❑Everett School Dist ❑Mukiite Dist <br />Additional Notes: n rJ I PV��iDt(s°f' t <br />Approved By: 01 Date: q <br />13UEWIC WbR}CS:: <br />Intake OK by: Date: 9 13-0 <br />•.••..•..•••..•••,........... .,........ w..... ....................... ..•••.•.••••..... <br />�;•,..,.•,..,•...•.•-••W, ••„•.W. <br />Intake Comments: 'PW Worksheet Needed if., <br />.a -r6.0. s._ a ❑Sys Dev Eval ❑Traffic'Mit Eval <br />€J]Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />?(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />c•....�••......•••..w............................. ...... _..•........ •._•..._...••.•.•.... ,..••... <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 (join with this folderfor permit issuance) <br />❑ WIII be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />X"blic Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved ay: Date: <br />�2- <br />