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Intake &Approval Sheet IIIIIIIIIIFOR PERMIT STAFF ONLY) PERMIT# G 150 8 001 <br /> BUILDING PLANNING <br /> Intake OK by: Date: //S'//8 Intake OK by: Y..14 Date: <br /> Intake Comments: Intake,Comments: Assign To. 'r.t^9e1,40,. <br /> dd r4 <3n 'i-1 )or— lad re .2.) Con ir <br /> /► ar'Y,c <br /> ebAtr-,tet. k x yds — 0 k, ham <br /> ❑ Route to Commercial Building 0 Attach to Project No._. / t(J <br /> Route to Residential Building 0 Route to Historic Reviewer (Circlet/7'60S re-e of !r fi <br /> ❑ Make this a"W" Permit ITOtoRoute to Other Departments l,0VL*t `1 <br /> K "Y r' I <br /> ,Z�� �' <br /> tldg I/Addn/Rem Size � g � Hold in Plar�� is10 ,30w8r 130,fir <br /> Garage/Accessory Struct. Size 349 S,i .' Zone /2-r,i <br /> Number of Stories '2 Overlay/Agreement <br /> Basement ,ZNo ❑Yes , Fin/Unfin Nonresidential Use ..."-' // <br /> Type of Construction it Residential Use b14 p Led., - COf?G(0 <br /> Occupancy Group Proposed No. of Dwelling Units: 2 <br /> Occupancy Load Total No. of Dwelling Units: 2. <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? tlDYes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ t . -3f 230 <br /> Reason Fire Alarm Required: Cal ulated: Credit: t1/DAlE <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No LJEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: -77-141S Lok 1S ✓e L d ,— <br /> VALUATION <br /> VALUATION CALCULATION: Total $ 57,11-30 oohdo l'ten--' <br /> Approvedef FIN Date: 12/41/1 g <br /> PUBLIC WORKS <br /> Intake OK by:"q -00-) Date: a bA-/ le <br /> Additional Notes: 2 0/S /, 'C 4. //tiS` C Intake Comments: PW Worksheet Needed if: cuss <br /> vo +6 <br /> S t-rea.A.4-c Gu s h-s 41'."" s 4it�Ev. <br /> L$Sys Dev Eval Traffic Mit Eval <br /> 'Do-A.a.iAp[ GA-C?o,ti'r IiSite Work or Drainage Proposed <br /> 11'94'4100' 22 1.4"4". "'I"'I ❑Backflow Prevention for high hazard: <br /> Approved By: cid Date: /AO,9 <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ERoute 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 IADeferred <br /> ❑Sending Fire Notes to Project Team fig-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 4-,-Separate PW Permit is Required (Permit#: PW 9 SO 6- 0-76) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: OUpdate Existing ❑New System 0 Not Req'd a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: -7/.f/3rdtoirt upae/ /14J �i� 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 By:-r,/_ - - , Date: //z3Z3 C 7 <br />