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1-COLI44A- — U i t' I I-Q©2 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0.) Mlio 092 <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 21 La Ell 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Lill `t" Zone , , . W Cir <br /> Number of Stories !i Overlay/Agreement TDD - pj e r4 w <br /> Basement 5INo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of ConstructionResidential Use 5FQ <br /> Occupancy Group Z-1 11-i Proposed No. of Dwelling Units: 1 <br /> Occupancy Load Total No. of Dwelling Units: I g/ <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes L/No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ ,F <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ tet of veec.L pa cL <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 /> ¶4LUATION CALCULATION: Total$ 2-55 I ibb2-,cs- <br /> 2ot6 112-G4W6 & I <br /> pproved By <br /> ADate: ,ZlQ Ci <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: dit Date: SAO //q ❑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 /> El Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team El This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 12 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd N A Separate PW Permit is Required(Permit#: PW 10166-0,5 ) <br /> Fire Alarm: ❑Update Existing ❑New System ❑ Not Req'd AND '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: ❑ 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 /> l 111 Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: ArcA— Date: 6(i /24601 <br />