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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# e( gI( 0/0 <br /> BUILDING r PLANNING <br /> Intake OK by: Date\,! G / tile Intake OK by: Date: <br /> Intake Comment : 1 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 /> Bldg/SPAddn/Rem Size €✓tom 44 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone -L..-\ Ii\kU nn,,Q..1 <br /> Number of Stories . - Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use v\Ce. <br /> Type of Construction \ ii* Residential Use <br /> Occupancy Group R.` .1. Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: M Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: PUpdate 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 Pg No CI Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ItNo Additional Notes: <br /> VALUATION CALCULATION: Total$ S t., O <br /> Approved By: (--____;:s —'� Date: \\, C)CQ- z...ovr <br /> PUBLIC WORKS <br /> Intake OK by. � 5 - Date: ii WORKS/ <br /> • <br /> Additional Notes: Intake Comments:- r1.. - PW Worksheet Needed if:: AWE <br /> 3SSFu� �y,,011 t,��l�}�yY��l]Sys Dev Eval ❑Traffic Mit Eval <br /> �'�l�?��% IAO �Oi _ Mite Work or Drainage Proposed <br /> Approved By: Date: 12141 t8 `--A/0 e1 Je - ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT CI 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 Cl Create Green Folder ❑Submitted Previously CI 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: PUpdate Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: tlUpdate Existing ❑New System 0 Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 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 /> Approved By:�j /j(, Date: )2I 9/ i6 KPublic Works has no scope---PW Not Required <br /> i / Additional Notes: <br /> LECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: C /Date: /�46 f� <br />