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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# C I" 1 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: (/lit/i? Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> 1 Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> BldgfTl/Addn/Rem Size 17Ge S 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories 1 Overlay/Agreement <br /> Basement C8No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction cJZ1> Residential Use Wko\A.e Y‘y <br /> Occupancy Group 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? ❑Yes ETNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate 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 rallo DEverett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes r3No Additional Notes: <br /> VALUATION CALCULATION: Total <br /> 60 <br /> CDI DOD. <br /> Approved By:c Date: �. Z \,9 <br /> PUBLIC WORKS <br /> Intake OK by:" T Date: 1 / 2'- .26, 1 9 <br /> �rg,-- PW Worksheet•Needed if. <br /> Additional Notes: Intake Comments: <br /> 'RI?Las,a f. l A Aw1vF. , Sys Dev Eval ❑Traffic Mit Eval <br /> 1--o t-&.... ❑Site Work or Drainage Proposed <br /> Approved By: Date: 2/7//7 -1)% cuSSC'I> At.._ OBackflow Prevention for high hazard: <br /> 61s. :(dental,medical,animals,mortuary,hospital, <br /> 'DFv <br /> s. Ca dft� _ w�P :ssuppor ive housing) <br /> rt— <br /> FIRE DEPARTMENT Route 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 This Permit-is Approved by Public Works <br /> Date: (OK to Route to Other Departments) ❑ See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DUpdate Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW <br /> Fire Alarm: DUpdate 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(join with this folder for permit issuance) <br /> Additional Notes: tot it ft/(�►�,6`C/ll`" 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: U Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL ta,a Stets . E.) ¢ rrz=s , TtE'�t_oty g.41 -c <br /> Additional Notes: �..wGA c-..,c•..�;� �+.►E <br /> Approved By: Date: Approved = i_ tl Date:/T2 <br />