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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# CaU i "043 <br /> BUILDING PLANNING <br /> Intake OK by:r____ Date: ? 1$ Intake OK by: Y..-t-r Date: <br /> qJ?) AC( <br /> Intake Comme Intake Comments: Assign To: N ' <br /> 01:e.„ cibeiy‘M oN... Q , ' <br /> 4reetS <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 /> Bld /T ddn/Rem Size t k2 eel old in Planning File Drawer -ioJj Y-� <br /> Garage/Accessory Struct.Size — Zone UY-A <br /> Number of Stories NA Overlay/Agreement Ii `\''iO4\ CacmpA.4- <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use 0'0.4-i 0tt i(a,t , <br /> Type of Construction 'Tl.-` Pk Residential Use <br /> Occupancy Group $ Proposed No. of Dwelling Units: <br /> 7 <br /> Occupancy Load 11-7- Total No. of Dwelling Units: <br /> Fire Sprinklers:0Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IZAlo <br /> Reason SprinklrsRequired: ..)t«,-1-‘..ret F,Rt sitt .r.i. "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Update Existing El New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: ( \cry`,o Spm Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add',RCW 64.55 docs required prior to final? t�❑Yes ONo Additional Notes: <br /> VALUATION CALCULATION: Total$ 42.1 FpS� <br /> Approved By: it- l:I Date: ion- 1 <br /> UBLIC WORKS <br /> Intake OK by:_, 4.)116.-E.7± Date: fZg/.A1g <br /> Additional Notes: Intake Comments: PW Worksheet Needed if:AMA <br /> No ,- a _ ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Mii ❑Site Work or Drainage Proposed <br /> Approved By: ' <br /> foe te/9''l 18 V� ❑Backflow Prevention for high hazard: <br /> (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 /> ❑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:4K1Update 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 ❑New System a Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ��,/ ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> , <br /> Approved By: e R Date: ij- ` I a �^J.Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: - Date: 772‘40 <br />