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��o140nn t? tail t81I-©b1 2 <br /> Intake &Appr�.val Sheet T (FOR PERMIT STAFF ONLY) PERMIT# C tot a <br /> BUILDING <br /> Intake OK by: Date: Intake OK by: PLANNING <br /> 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 11 Pb/("�� <br /> Bldg/TI/Addn/Rem Size 1 U 34. 43 0 Hold in Planning File Drawer J�.a,VQX' V <br /> Garage/Accessory Struct.Size 92i' t Zone VV D <br /> Number of Stories 2. Overlay/Agreement F/to — -yeo istt rf <br /> Basement 14No ❑Yes , Fin/Unfin Nonresidential Use <br /> v <br /> Type of Construction Residential Use sf-i2• <br /> Occupancy Group g J vtd Proposed No.of Dwelling Units: I <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 'No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing DNew System ONot Req'd School Impact Fee: Total $ -tte3 ? '4 d_ -ev <br /> Reason Fire Alarm Required: Calculated: Credit: tX t"s <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? ❑Yesr� /❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ �a,JO 2'.01) <br /> I ,i(26, w S & Approved B . "' Date: 2b 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: S1/0//9 ❑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 /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 124 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: ❑Update Existing ❑New System 0 Not Req'd ►.1 A Separate PW Permit is Required(Permit#: PW n06-0311 ) <br /> Fire Alarm: ❑Update Existing Chew System 0 Not Req'd AND IQ 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: 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> 1iproved By: Date: 0 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: / n,� <br /> Approved By: Date: Approved By: ,� Date: 4114 . 4O <br />