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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#0(IV,' 002.. <br /> BUILDING PLANNING <br /> Intake OK by: Date: Ct/57/ 8 Intake OK by: kk Date: q. <br /> Intake Comments: Intake Comments: Assign To: 1/-- <br /> 4-z) aika.,3 SIS Oa- fila <br /> Cpnte✓sb^ 41Gc tS -030 <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/TI/Addn/Rem Size pg.Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone (L,--2— <br /> Number <br /> Number of Stories 2.. Overlay/Agreement <br /> BasementNo Dyes , Fin/Unfin Nonresidential Use <br /> Type of Construction R Residential Use <br /> Occupancy Group e A). Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes I(lo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System rEiNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yesrr No ❑Everett School Dist ❑Mukilteo School Dist. <br /> Add'I RCW 64:55 docs required prior to final? ❑Yes QNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 09 9!c <br /> ifs S`�' 5 <br /> Approved By: Y. ' tij Date: q- 3-'‘ <br /> 2.3v' e <br /> PUBLIC WORKS <br /> Intake OK byrT'R..1 Date: 4/6/ffa <br /> Additional Notes: 2c9/5- (46 4 kV SIC Intake Comments: PW Worksheet Needed if: <br /> NO PArs ScorrtC• ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> n�tEw Itobf• o.aarY ❑Backflow Prevention for high hazard: <br /> Approved By:"1-6Date: Ql f <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT 121Route 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: ❑Update Existing ❑New 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 ❑ 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: Date: %Public Works has no scope---PW Not Required <br /> Additional Notes:.�' �.../1 !// lid`S <br /> ELECTRICAL 9j <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />