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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 61/0‘A(.)\-00 <br /> 1. BUILDING PLANNING, <br /> Intake OK by: Date: ( t Qf Intake OK by TA ' Date: d VS 410 • <br /> Intake Comments: Intake Comments: 4111 1 lb <br /> Assign To: • <br /> S; cs <br /> O 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 IR OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem S' e � 0 Hold in Planning File Drawer <br /> Gar ge/A c so Str ct. 51ze ZF0 S' /513i $� Zone _ 2. <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No DYes , Fin/Unfin Nonresidential Use <br /> Type of Construction --SZI? Residential Use S'.`( <br /> Occupancy Group u Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑ es ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: n $ <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? DYes 931 No DEverett Scho ist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes Flo Additional Notes: cpt'we,„1ny wo.4, ‘oe.ccx.t2.&. <br /> VALUATION CALCULATION: Total $ -23/ 6,7O SCt Itotivktrik <br /> +�QC� " Z cert. SpOkC�$ <br /> cd. as rec�. c�.. s` <br /> Approved By: Date: S SC). ZCAC1 <br /> PUBLIC WORKS <br /> Intake OK by: - Date: /I d/meq <br /> Additional Notes: Intake Comments: PW Worksheet N edrd�. an <br /> ed if.fuj ,pil+ <br /> �i� <br /> r�/ Pi— I$[Sys Dev Eval',$ Traffic Mit-Eial <br /> d . rrouxi ,Site Work or Drainage Proposed\l <br /> Approved By: dl' Date: 2/7//41, 74fr S-s//y�Ep Am* OBackflow Prevention for high hazard: <br /> 0 444,10-10//t) <br /> 44, 7 f/) (dental,medical,animals,mortuary,hospital, <br /> = = <br /> ='- - ' supportive housing) <br /> Y o�v <br /> ,T4FIRE DEPARTMENT �Route tf$s 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 td <br /> Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) tl See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing :hew System 0 Not Req'd 5 A Separate PW Permit is Required (Permit#: PW )4104--0404--) <br /> Fire Alarm: ❑Update Existing ONew System 0 Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd ► 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: <br /> ELECTRICAL <br /> Additional Notes: <br /> l <br /> Approved By: Date: Approved By: '�--�t•� ... , Date: 0 ,0J <br /> pp pp ----�.._ <br />