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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# --?)1 \2-,--602--, <br /> BUILDING PLANNING <br /> Intake OK by: Date: 12rrJ 4 1.$ Intake OK by "J Date: 1211-1 /i <br /> Intake Comments. Intake Comments: Assign To:12. 1/✓e(c{©i <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit Lv7 O/K to Route to Other Departments <br /> Bldg/TI/Add ap.ize 142.. SjIold in Planning File Drawer <br /> Gara• - cesso ij truct. Size t ivipstel(o jr, Zone .. R- <br /> Number of Stories I Overlay/Agreement <br /> Basement gNo ❑Yes , Fin/Unfin Nonresidential Use — � <br /> Type of Construction Residential Use Gj �L - � "-If. <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: r� Calculated: Credit: <br /> ❑ .. <br /> RCW 64.55 MF worksheet req'd for permit? <br /> Yes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes .No Additional Notes: <br /> VALUATION CALCULATION: Total$ C2 ,012 <br /> tq(s,6 0 e 25/5-e• 0240 1") 46i.11.5oApproved Date: Zl I N 'I D <br /> t)4714a(9041 <br /> 4y e-gtOk,> - >✓oa2 aaAt3 gg4025 PUBLIC WORKS <br /> 1A-0-Pe hi-,- `7l00 Intake OK by:Q'a Date: 12 f o 4 fzora <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> Ace—c.s.s00--r G A0495 ❑Sys Dev Eval ❑Traf is Mit Eval <br /> Fort. 6 4- Gs►%vtat%lo*I ❑Site Work or Drainage Proposed <br /> -ra Amu c,—T h A�•_-; <br /> Approved By: <br /> ❑Backflow Prevention for high hazard: <br /> �f Date://29//9 oE. <br /> f' `L - N (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Route to Fire Drawer---FirePreliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑update Existing ❑New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing [hew System 0 Not Req'd 0 Is in a Separate Green Folder Goin with this folder for permit issuance) <br /> Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: lid Public Works has no scope---PW Not Required <br /> Additional Notes: ...?___. <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: \' _ <br />