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2C01-15- I , Ulbil-002-- <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT#(i I et 01— DI 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> ake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building Ll�Attach to Project No. l 4 —c02_0 Route to Residential Building <br /> 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit <br /> 0 OK to Route to Other Departments <br /> Bidg/TI/Addn/Rem Size 2,1 DI 4 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Lill Zone \N1 C <br /> Number of Stories -• Overlay/Agreement I'iC) <br /> Basement iNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use CzzE2— <br /> Occupancy Group nA./ Proposed No. of Dwelling Units: �� <br /> Occupancy Load Total No. of Dwelling Units: j ,/ <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes N o <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System ❑Not Req'd School Impact Fee: Total $ pal, G( <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'l RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 2-55 I sb3Z,lJP.--- <br /> • /1)15 1'RG 4 W 4 B0 <br /> Approved B . Col�Date: / I <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traf is Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: V r l' Date: -21110/1 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT El 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 g This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) igSee PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd I A Separate PW Permit is Required (Permit#: PW)90'-04' ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND g 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 /> ^oproved 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: AZ4--- Date: 71a9/ <br />