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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 3 1 q eg -0 O- 1 <br /> • BUILDING PLANNING <br /> Intake OK by: Date: g//7/0 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 a"W"Permit 0 OK to Route to Other Departments <br /> Kg I/Addn/Rem Size i(o Zo S"1 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone R-3 <br /> Number of Stories ' Overlay/Agreement <br /> Basemento ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Vi? Residential Use r,,D1042_ IAOA-e- <br /> Occupancy Group P Proposed No. of Dwelling Units: i <br /> Occupancy Load ��,{{ Total No. of Dwelling Units: 1 C.an J(Lis 1a1*) <br /> Fire Sprinklers: ❑Update Existing Chew System l� Jot Req'd Planning/Landscape Inspection Required before Final? ❑Yes'F4No <br /> Reason Sprinklers Required: ,�( "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing [New System W 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 igi No El Everett School Dist ❑Mukilteo School Dist. <br /> Add'I RCW 64.55 docs required prior to final? DYes tErNo Additional Notes: RQfI , <br /> A- V <br /> _'`, <br /> VALUATION CALCULATION: Total$ jl(gip® Q2CI5�7 r � <br /> Approved By: y..._.1.1e.,.., a Date: 46-11-)‹.( <br /> PUBLIC WORKS <br /> Intake OK by: 1 Date: A/i-7/!8 <br /> Additional Notes: j`$- / Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> f 1\10 �OVC <br /> Approved By: ❑Backflow Prevention for high hazard: <br /> . Date: q ho <br /> N.lb .5 'S ''FiJ - (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ICJ" Route this folder for PW Review at end ---PW Review�ks <br /> Intake: (Needed forTownhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El 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 Depart ents) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System J2 of Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New Systemof Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing <br /> EI System Not Req'd ❑ 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 /> Approved By: Date: ?;---Z2,71 . 1 Public Works has no scope--- PW Not Required <br /> O. <br /> Addition ote _ <br /> ELECTRICAL ' l ii i i <br /> Additional Notes: <br /> Approved By: Date: Approved By:114d VkA I e}(1r/t Date: <br />