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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# (5I 12.--b n <br /> BUILDING PLANNING <br /> Intake OK by:_� Date: 1211�t(/s Intake OK by� MI ) II <br /> Date: � g <br /> Intake Comments: Intake Comments: Assign To: <br /> Route to Commercial Building 0 Attach to Project No. <br /> la Route to Residential Building 0 Route to Historic Reviewer <br /> 0 Make this a"W"Permit ❑OK to Route to Other Departments ia've/is. <br /> Bldg/TI 'dd Rem Size 5 . r ErHold in Planning File Drawer <br /> Garage/Accessory Struct. Size SI-t S Zone P-- - <br /> Number of Stories I Overlay/Agreement NONE <br /> Basement 1%1No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction z_-g Residential Use Sjq2— <br /> Occupancy Group 12/(.t Proposed No. of Dwelling Units: N0k1E <br /> Occupancy Load Total No. of Dwelling Units: I <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 ❑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 Xj No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes EiNo Additional Notes: <br /> VALUATION CALCULATION: Total$ zat -(9-'6 <br /> 54i C etc, 249° <br /> 35@ Ill, 40‘0 <br /> Approved By Date: 12_12(0 I is <br /> PUBLIC WORKS <br /> Intake OK by:---n-1 Date: /211, /ZO/`r3 <br /> Additional Notes: Z.,0 /.c OM * W SSG. Intake Comments: PW Worksheet Needed if: <br /> .L--„Pe¢-Ac . Prov l).6/4 NtSys Dev Eval ❑Traffic Mit Eval <br /> ".JI-ra I.-CsS TN0..-% ;]bite Work or Drainage Proposed <br /> Approved By: CA4 <br /> Date: //27M. Zo 0 sG .-tas �a -Q�vc,. <br /> p� �.� r�s ❑Backflow Prevention for high hazard: <br /> ” £2(iw+.-c <br /> ,4 (dental,medical,animals,mortuary,hospital, <br /> .s l sys bV 10 ;.4 i, supportive housing) <br /> FIRE DEPARTMENT FA r oute 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 O% This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) C 4 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd • 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 [hew 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes:. <br /> Approved By: Date: Approved By -% 7 <br /> '. ate;o/f 412,0/ci, <br />