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Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# IsM "0---\ I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this ' Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rer <br /> e1'n- 4 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone 15-2- <br /> Number of Stories / Overlay/Agreement <br /> Basement aiNo ❑Yes, Fin/Unfin Nonresidential Use ^e,A\ / `Secv ICS 5411-trN <br /> Type of Construction VS Residential Use <br /> Occupancy Group 11 Proposed No.of Dwelling Units: <br /> Occupancy Load 2;7 Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System tcsNot Req'd Planning/Landscape Inspection Required before Final? DYes I"No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ❑New System &lot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 0 No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes ONo Additional Nptes: 11 O 1 no c 4 l ,,1 <br /> o" yr 4atb) <br /> VALUATION CALCULATION: Total$ (e7. 4 -4-i,, ciQ.,� - i <br /> 1 <br /> Approved By: IL, Date: ci—"ZC(...-11( <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments:_ PW Worksheet Needed if: <br /> 3 owd p 514. ❑Sys Dev Eval ❑Traffic Mit Eval <br /> (iaM pd� 4' a5 iiJtt{ Site Work or Drainage Proposed <br /> osrE_ ❑Backflow Prevention for high hazard: <br /> Approved B Date 9/ g� � S to A .Ol (dental,medical,animals,mortuary,hospital, <br /> „,0Q Wyk 1 ,(s upportive housing) <br /> FIRE DEPARTMENT EIRoute 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 /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team )= This Permit is Approved by Public Works <br /> Date: 10 -Z-I. g (OK to Route to Other Departments) IN See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: 0Update Existing ❑New System 0 Not Req'd IN A Separate PW Permit is Required (Permit#: PW 1609-046) <br /> Fire Alarm: ®Update Existing ❑New System 0 Not Req'd AND Bills located in this folder <br /> Chemical Sup: DUpdate Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder Coin with this folder for permit issuance) <br /> Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:I H Date: I D -2. 8 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved y: Date: /dip 912o 8 <br />