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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# $1A) I b 4 'W2- <br /> BUILDING / PLANNING <br /> Intake OK by: ` Date: 11.IQ 1$ 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 /> KI-Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 2--70 b • Zone <br /> Number of Stories I Overlay/Agreement _ <br /> Basement , No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction V3 Residential Use <br /> Occupancy Group LA Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑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: ❑Update Existing ❑New System [hot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes R No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add]RCW 64.55 docs required prior to final? ❑Yes IgNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 4spp <br /> Approved BC::- Date: /1/4,// <br /> PUBLIC WORKS <br /> Intake OK by: l4 Date: 11 1 14'I r S <br /> Additional Notes: 2(.2/ /!LL Intake Comments: PW Worksheet Needed if: <br /> ,r14.4 c.ov><.cz ov<4„cL ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 6.-At ST...ac., 'DEc.K. ❑Site Work or Drainage Proposed <br /> Rz.a 0.40,1‘5 -'o '�L-a GI ❑Backflow Prevention for high hazard: <br /> Approved By: +- Date: rZ/A 7/is, -(+F,Q„iy.-C, (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT tirRoute 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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team IZ--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 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder Goin with this folder for permit issuance) <br /> Additional Notes: 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B,.--7,.:17.:- <br /> fir. --- ;y Date: 02k10lip lB <br />