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2CQL\ q-" 1 t 11- 002 C i o- 00 <br /> Intake &Appr•;val Sheet (FOR PERMIT STAFF ONLY) . PERMIT# 1 <br /> _ <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> ake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building I2 Attach to Project No. i0 u/0/ 1- ��2 <br /> o 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 2102 [i 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size i-111 Zone . W C' <br /> Number of Stories Li Overlay/Agreement PPD <br /> Basement CANo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use S i2 - <br /> Occupancy Group w Proposed No. of Dwelling Units: / <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes Ed <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Am nt$ <br /> Fire Alarm: ' ❑Update Existing Chew 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$ 2-551 '?• 2.,09-- <br /> , 2015 \P-C) 4 W600 <br /> Approved Date: /'T <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if, <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: 7/1/ /�g ❑Backflow Prevention for high hazard: <br /> r ` (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 Dotes to Project Team This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) Ed-See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd 'A Separate PW Permit is Required (Permit#: PW/90'-Oy2 ) <br /> Fire Alarm: ❑Update.Existing ❑New System 0 Not Req'd AND Iiirls 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 /> A()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: _���� Date: `/, <br />