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Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# Ea0P32/4 <br /> BUILDING PLANNING <br /> t <br /> Intake OK by Zi7711- Date;-O// 5`/Lo/9 Intake OK by:( ? Date: `. <br /> 1� <br /> Intake Comments: Intake Comments: Assign To: <br /> WI tic o,1‘ eiv"tai 1 5 4' A 1. A <br /> zilt8 11q 'E 11'60 <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> 0 Make this a"W" Permit Ill OK to Route to Other Departments <br /> Bldg I/ ddn/Rem Size 4/fid ,cS'F .�®-rtoia i 1 -r <br /> Garage/Accessory Struct.Size 44 Zone '0 <br /> -r WW1 iu l(0 <br /> Number of Stories / Overlay/Agreement <br /> Basement ❑No C&IYes ,6_9/Unfin Nonresidential Use `(" S ttio k0 i IGi-----S <br /> Type of Construction lig Residential Use Yaw I 4.) i ta <br /> Occupancy Group 5/4 Proposed No. of Dwelling Units: C.,'" V}' j(�/� ty" atf/j?�� <br /> Occupancy Load /7 Total No.of Dwelling Units: .P6V1-15-1D5 �_,/ <br /> Fire Sprinklers: DUpdate Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? DYes 2/No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: DUpdate 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? DYes ® No DEverett School Dist DMukilteo School Dist <br /> r <br /> Add.]RCW 64.55 docs required prior to final? DYes IJNo Additional Notes: <br /> f n r 11 91 Va°11 <br /> VALUATION CALCULATION: Total$ /0 000>co Ta,l(la l WV <br /> b t <br /> Approved By:t.------ ''/" Date: q I I i.J j q <br /> PUBLIC WORKS <br /> Intake OK by: 1 I4-i Date: 112..4/1 I <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> .�I kl-nr_w)ci v,,012..r_ 004-1 ❑Sys Dev Eval ❑Traffic Mit Eval <br /> —1..E s5 -1-14A.4 - coLss ❑Site Work or Drainage Proposed <br /> 0:-V e.a"°cz- V`i"zip ❑Backflow Prevention for high hazard: <br /> Approved B ".., Date: oSioj/?Cf/�f Lo -p4 Sc ',r 7G (dental,medical,animals,mortuary,hospital, <br /> v�v supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) DThis 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: DUpdate 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: DUpdate Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: Nb Ft / ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: t-,,\JCOwh Date: -(p-i q I4-• blic Works has no sco.e--- P Not Req`red <br /> Additional Not- .-"% <br /> 1 i12 4 //9 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />