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5 \ 1 O ®02 l <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#C 1 bJ 00'"1 <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 ❑ ute to Historic Reviewer <br /> ❑ Make this a"W"Permit aOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2) 0 2 [11 0 Hold in Planning File Drawer <br /> C \v <br /> Garage/Accessory,Struct.Size `�j � 41Zone �. 1A, <br /> Number of Stories 2. Overlay/Agreement thiSICAL 1 IGW <br /> Basement V,INo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use G' <br /> Occupancy Group 11.L Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes Ne <br /> lo <br /> Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ TGU t <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0 N Additional Notes: �"'– <br /> VALUATION !!CALCULATION: Total$ 5 ,1 tQa•0® <br /> '2015 A' WSJ& Approved(B/ Date: 3 1 ' 119 <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: .7/Z641, ❑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 El Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team Iiit This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 10 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/103-05C ) <br /> Fire Alarm: ❑Update Existing El New System 0 Not Req'd AND CSVIs 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: Li Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> -I—proved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> AM"Approved By: Date: Approved By: Date: 3/7g/ / <br /> r iIII. <br />