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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 22i1.0-- a <br /> BUILDING PLANNING <br /> Intake OK by: Date: kb)c fes/Ig Intake OK by: %r Date: 0-0'1 . <br /> Intake Commen dd 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 /> O Make this a"W"Permit (3 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 1.91 4{7- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone Z.-- <br /> Number <br /> �Number of Stories 3- Overlay/Agreement <br /> Basement INNo ❑Yes , Fin/Unfin Nonresidential Use ` At,Arq^/r' <br /> Type of Construction NI e> Residential Use <br /> Occupancy Group 1}- a Proposed No. of Dwelling Units: <br /> Occupancy Load 1 - Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 17:1No <br /> Reason SprinklRequired: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ❑New System El Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes A No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ,No Additional Notes: * 5kJ "- E' i' ' c j"c <br /> 1 <br /> VALUATION CALCULATION: Total$ a Cen9 v <br /> Approved By: ‘,1_,:\\(.. . Date: \\_). <br /> PP PUBLIC WORKS <br /> Intake OK by: r/ _ Date: /16//0/7,0/8 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> SEE 451 t s/ ,pC4/', ❑Sys Dev Eval ❑Traffic Mit Eval <br /> etANEE / l�f'N�sH6�Ni gSiteWork or Drainage Proposed <br /> Approved By: Date: (0/12,/le, El Backflow Prevention for high hazard: <br /> /Pp (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT A 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 /> O Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team KThis 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 I Not Req'd A Separate PW Permit is Required (Permit#: PW 1811- 0 &J4 ) <br /> Fire Alarm: Update Existing ❑New System 0 Not Req'd AND 16.1s located in this folder <br /> Chemical Sup: ❑Update Existing ❑New Systemt Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: 1411 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ,%e3 Date: 14/-eD �� 0 Public Works has no scope--- PW Not Required <br /> / Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved �1.---" Date: Il 11+12,6a <br /> 2,6I <br />