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6V\ 1 of an m i D- ©o2 <br /> Intaken ��_ <br /> Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT# C\� OO"J <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> ake Comments: 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 /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size //) Q('Z tt 0 Hold in Planning File Drawer <br /> Garage/Accessory,Struct. Size 2/ 1 ni Zone , • ', �Ci <br /> Number of Stories 2.. Overlay/Agreement 1' c c,4 r Mian _ <br /> Basement til No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use Gj <br /> Occupancy Group 1 w 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 J I11 <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ ..... 2-Ad, <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> ROW 64.55 MF worksheet req'd for permit? ❑Yes 0 No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: `--- -- <br /> VALUATION CALCULATION: Total$ t6? Ii 0.° <br /> 9,0t5 )12-ci 2fWs V Approved Date: r�j1 +q <br /> 1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: 9. c1 f iA ❑Backflow Prevention for high hazard: <br /> `' g (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <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 taThis 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: ❑Update Existing ❑New System 0 Not Req'd RA Separate PW Permit is Required (Permit#: PW/9O3—OS/ ) <br /> Fire Alarm: El Update Existing Chew System 0 Not Req'd AND Ws located in this folder <br /> Chemical Sup: ❑Update Existing Chew System 0 Not Req'd 0 Is in a Separate Green Folder Goin with this folder for permit issuance) <br /> Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ^['proved By: Date: 0 Public Works has no scope---PW Not Required <br /> I Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: _A;- ia 1 Date: 3/Rski <br /> (2.-4) <br />