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X 59)1 OM1D- 002- C 10�2 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT <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 RR ute to Historic Reviewer <br /> ❑ Make this a"W"Permit I"OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2) 062 1$ 0 Hold in Planning File Drawer <br /> Garage/Accessory.Struct.Size Y0 i► Zone W G <br /> Number of Stories 2., Overlay/Agreement Mics'f"v r .P Vivi <br /> Basement IANo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Useli <br /> Occupancy Group 1 Ud Proposed No. of Dwelling Units: 1 <br /> Occupancy Load Total No. of Dwelling Units: 1 <br /> Fire Sprinklers: ❑Update'Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes L3tiN; <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ TAt <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 l❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ ,6? ►l ( f 00 <br /> 9,Dt 5 l ! 4' VgZ61 Approved By:C '�I�� Date: .11 I)a/I el <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:4g � � ❑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,Alleyload 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 ES This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd El A Separate PW Permit is Required (Permit#: PW 19,03-051_ ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND 'Is located in this folder <br /> Chemical Sup: ❑Update Existing 0 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 /> tproved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes:Approved By: Date: Approved By: AS,c1" Date: 3/25124()21 <br />