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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# illkSk—C LA <br /> BUILDING PLANNING <br /> Intake OK b4• . (72-9/z0/43Date: <� ib ,--------\ Intake OK by: Date: <br /> Intake Comments: ` ` Intake Comments: Assign To: <br /> _ J •i di; • r <br /> ❑ Route to Commercial Building / 0 Attach to Project No. <br /> El Route to Residential Building / 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> BIdeAddn/Rem Size S// 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ,(/� Zone <br /> Number of Stories ( Overlay/Agreement <br /> Basement 151.No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction V,/J Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load rsr Total No. of Dwelling Units: ,�,/ <br /> Fire Sprinklers: ❑Update Existing ❑New System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes L2No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: JElbpdate Existing ❑New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Ef No El Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes glNo Additional Notes: <br /> VALUATION CALCULATION: Total$f3�LYJO <br /> Approved Date: J//01/I g' <br /> PUBLIC WORKS <br /> Intake OK by: I •I• Date: It f 2 4 /20 i$ <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> -7414-44.0.,wg,,J-1 ir_[Liaw4cemeo_r ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ... 1430 .S ❑Site Work or Drainage Proposed <br /> ,;P,A��.-t" ❑Backflow Prevention for high hazard: <br /> Approved By Date:pl y�/ �n'r �.c�„+a <br /> / (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT NI'sute 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 k4 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 El New System ❑ Not Req'd 14L4LSeparate PW Permit is Required(Permit#: PW 1812-0 too ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND V located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System El 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: 0 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved :v. ,-,-- -;01111211,-: '% -_ ` Date: /Z /27 IA /$�. <br />