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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# b i st('6. 2, <br /> BUILDING PLANNING <br /> Intake OK by: kir Date: I I l 14( lbIntake OK by --7.--- Date: U !�N. �` lal ' <br /> Intake Comments:, Intake Comments: Assign To: Oi\4tCe <br /> s'S OHO <br /> } •v: r.5 <br /> — 't51-- ,Oce = 207. @ 3S-`10. kow(lS \-1Vrtcl <br /> ►V <br /> l\5',c=4.0 <br /> ❑ 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 0 OK to Route to Other Departments <br /> Bldgaddn/Rem Size 122.5 4+" 0 Hold in Planning File Drawer ''11 <br /> Garage/Accessory Struct. Size — Zone Uk <br /> M <br /> Number of Stories 1Overlay/Agreement Z <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use CeSc\v\v <br /> Type of Construction V-fi. Residential Use <br /> Occupancy Group ', Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: UUpdate Existing ❑New System I Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing ❑New System XINot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes Irlex No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes O No Additional Notes: <br /> VALUATION CALCULATION: Total 30,aft''a (twvi . S fOk SF.A 4'04.6'GU"' <br /> Approved By: C-----7 _ Date: ,` V ,2da b <br /> PUBLIC WORKS <br /> Intake OK byrn.1 Date: t l 1 1'- J t 'o <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> �- ••J-cEf+-•en- 1NORt-1'T sDev lal DTrCD <br /> A 1. ❑Sys Dev Eval Traffic Mit Eval <br /> A4O q,�,��E o 46 ❑Site Work or Drainage Proposed <br /> Approved By: W Date: Iq�•I��Q� ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT iFORoute 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 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: DUpdate Existing ❑New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: Oupdate Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: Re. eft C Iitw 1.0 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ss� Date: /Z//?//k. Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL ` 12.6 ks <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />