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Intake &Approv 4 Sheet (FOR PE-1"/IT STAFF •NLY . PERMIT# cv61 0(2-00-1 <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 1 Y)56, <br /> it 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size L11 & E aahh, Zone V 4 Ci <br /> Number of Stories 9.0 Overlay/Agreement Yi0— R1\1QX4YInt <br /> Basement ]No DYes, Fin/Unfin 'Nonresidential Use <br /> Type of Construction Residential Use S F_ okeitkkik <br /> Occupancy Group 1,) LIU ,Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: 0Update Existing ®New System ®Not Req'd i Planning/Landscape Inspection Required before Final? ❑Yes FINo <br /> Reason Sprinklers Required: i"In Lieu"Fee:Type: Amount$ <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? ®Yes 0 No ®Everett School Dist ®Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ®Yes ❑No Additional Notes: <br /> ,VALUATION CALCULATION: Total$ 2-247,30&.co <br /> X15 tt2e.... 4 w6E6,, <br /> sApproved By: i ^' v`� Date: Lo [ I Cl <br /> 111 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: �" 6 9 OBackflow Prevention for high hazard: <br /> �C)/ (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 /> ORouteto Fire Drawer---Fire Preliminary Review Notice AND ®Create Green Folder ®Submitted Previously ®Deferred <br /> ®Sending Fire Notes to Project Team 0 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: 0Update Existing ®New System 0 Not Req'd vi A Separate PW Permit is Required(Permit#: PW!Roc-o% ) <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 aoin with this folder for permit issuance) <br /> Additional Notes: ® Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> "nproved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: I Approved By: )5E55 Date: 411$1/M <br /> k � 2 <br />