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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT# 6 Q$1(. b(Lf <br /> BUILDINGPLANNING <br /> _ <br /> Intake OK by: Date: Intake OK by( T Z Date: ©g Zyc <br /> Intake Comments: Intake Comments: Assign To: 4 cOICQ . <br /> &ac st &w` ca,Mesaered • .,•0.606.2.r, <br /> ;t.‘te. sq Se c.\c, 0.44-2 .. etkc n.t <br /> O Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit I.d! OK to Route to Other Departments <br /> :Id•F I/Addn/Rem Size 4 go SF 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,t Zd Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement I3No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction /3 Residential Use <br /> Occupancy Group j,( Proposed No.of Dwelling Units: <br /> Occupancy Load Z7 Total No.of Dwelling Un ts: <br /> Fire Sprinklers: ❑Update Existing [New System ®Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ['Update Existing ❑New System EiNot Req'd School Impact Fee: Tof tal $ <br /> Reason Fire Alarm Required: Calculated: ( Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes lallo ['Everett School Dist ❑Mukiiteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes mNo Additional N tes: ea eclfd4-t (Y.\ S, <br /> VALUATION CALCULATION: Total$ / 000.,OD Sv�NQ, ec6, & C\� \pCO1AMNMLA \ <br /> VM. <br /> Ce � - rv:,, AkAvA Roc c <br /> \r.4,‘.\ t. S4ef_lt <br /> Approved By: C—Thij Date: y,(yg. A9 <br /> PUBLIC WORKSIntake OK by: AE.?-sir--" Date: i/lRl1� <br /> i �1 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> V <br /> f 1 O S0,;�p/ Mite Work or Drainage Proposed <br /> 0 � ❑Backflow Prevention for high hazard: <br /> Approved B ' ,,Z Date:00;/z 9 (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for FLEW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has la separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green F` Ider ❑Submitted Previously ❑Deferred <br /> ['Sending Fire Notes to Project Team 0 This Permit is Appro ied 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 -171 Not Req'd 0 A Separate PW Permit is Required(Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New System JZ Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: 0 Update Existing ❑New System gi Not Req`d 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: f!cep J;� (.4, C 1 th/ 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: / Date: ///t 77/4- ,Public Works has no scope--PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: j\?.A- Date: ill g t��;t <br /> i <br /> c.I <br />