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3015 , ID- oo4 � � <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT# ., �"101 <br /> BUILDING PLANNING <br /> Intake OK by: <br /> 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 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 112--1-,\ Lh 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size -fZtlb Zone :. WC , <br /> Number of Stories 2. Overlay/Agreement PDO t OR <br /> Basement ENo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 6.if <br /> Occupancy Group OR, 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 ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> /� <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ i ee-3 /7 d-- <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? (LW, <br /> ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ l vr(0, O !u,OD <br /> 2 15 VLC) 4IA)6C) <br /> Approved By: e"-----4;T---y/ Date: V Is/f 1 q <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: ZQ/S- IAC 0 w S - Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> j ❑Backflow Prevention for high hazard: <br /> Approved By: � Date: //////7 (dental,medical,animals,mortuary,hospital, <br /> supportive housing). <br /> FIRE DEPARTMENT DRoute 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 I'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 EFA Separate PW Permit is Required (Permit#: PW 1901—MO ) <br /> Fire Alarm: ❑Update Existing [hew System 0 Not Req'd AND 'SIs 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 /> Mt 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: 1-16.-Mal <br />