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2C01-1 I ' Uif) l1-C°2 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLA) PERMIT# C l`" bd' ' <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 RDute to Historic Reviewer <br /> ❑ Make this a"W"Permit YOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2' 01. [p 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size • Lill `t" Zone <br /> Number of Stories Li Overlay/Agreement M as I C4 _ H A N' <br /> Basement CANo ❑Yes, Fin/Unfin Nonresidential Use -- <br /> Type of Construction Residential Use �% - <br /> 1 �.IOccupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: ! � � <br /> Fire Sprinklers: ❑Update Existing ❑ ❑ I <br /> New System <br /> Not Req'd Planning/Landscape,Inspection Required before Final? DYes :2 <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El 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 0 No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> AIDLUATION CALCULATION: Total$ 2-65 I `q V32.,09.-- <br /> U16 <br /> ✓U16 11i.6 4 WGb <br /> Approved By --4=';;; ;FsilDate: 113 I (cl <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 /> 0Site Work or Drainage Proposed <br /> Approved By: ci Date:3/Z 6.41 ❑Backflow Prevention for high hazard: <br /> (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 /> DRoute 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) le6 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd IRA Separate PW Permit is Required(Permit#: PW IM–egg ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND Kis 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: ❑ 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 /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: a '' Date: 424/2.9'19 <br />