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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 3(',0;— 06(0 <br /> BUILD1NG PLANNING <br /> NV <br /> ¢ � 4 r <br /> S ,• <br /> Intake OK by: a Date:2 tel tl"( Intake OK by: Date: <br /> Intake Comments. Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> O Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 4Ato 4A-' 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone U\ Iv\ <br /> Number of Stories /— Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction "I.—lil> Residential Use <br /> Occupancy Group 'fp' Proposed No. of Dwelling Units: <br /> Occupancy Load 3-1- Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System KINot Req'd Planning/Landscape Inspection Re. 'fired before Final? ❑Yes ❑No <br /> Reason Sprinkl rs Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: p Update Existing ❑New System ❑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 �ry No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 1G�INoAddditional Notes: <br /> r \► <br /> VALUATION CALCULATION: Total$ �-'3/ D� \ \S q�`MiN . �''` \n1\ Q u� Nk -44 5 c_ <br /> Approved By..f •• Date: -\S ZOva <br /> & PI.1 ,04 0:40 Y <br /> h <br /> Intake OK by: 93,A Date: Z /5 <br /> Additional Notes: <br /> Intake Comments: PW Worksheet Needed if: <br /> ,, !L Sys Dev Eval 2 4ITraffic Mit Eval? <br /> L.vh ritt ACMv ❑Site Work or Drainage Proposed <br /> 0 P SV4"^ ', ❑Backflow Prevention for high hazard: <br /> Approved By: Date: f�✓/1R 9 <br /> ��'1142141; <br /> ,/1N2•v (dental,medical,animals,mortuary,hospital, <br /> _ v 0R1 reit# ,IMO( T""„ ,3 M „ 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 /> D 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 Mew 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 Su.: ❑Update Existing❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Ad• al Notes: <br /> APublic <br /> ❑ Will be issued separately(Separate Green Folder,PW issued ahead of BIddg) <br /> W.ADD -FIRE FE. - -r-„' Works has no scope---PW Not Required c,(/0�'?-O/7 <br /> .. ..-: : ,,(SawnDate{ 71 / Additional Notes: <br /> Additional Notes: <br /> Approved By: Date: Approved By: r-7, Date: 0-1 /J <br /> �Z <br />