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12t-10 i$lb- 00b <br /> Intake & Approval Sheet (FOR .''ERMIT STAFF ONLY) . PERMIT# V IA tn 0 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> ake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building INVAttach to Project No. Z, ✓I I -00 <br /> O Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments , <br /> Bldg/TI/Addn/Rem Size Q 013 01 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size IA s5. KO Zone WC., , <br /> Number of Stories 2 Overlay/Agreement 1200 <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction 0 Residential Use <br /> Occupancy Group g--11A, Proposed No. of Dwelling Units: r <br /> Occupancy Load Total No. of Dwelling Units: ‘, <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes NNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: A ount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ ,tl <br /> Reason Fire Alarm Required: Calculated: Ciedit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> Dv <br /> . 6J <br /> UATION CALCULATION: Total$ /AID t ' .- <br /> (2,015 1(.16 4WSEClQ iL ' //q ` <br /> Approved By Date: g/ <br /> Lo <br /> PUBLIC WORKS 111 <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> El Backflow Prevention for high hazard: <br /> Approved By: ht. Date:-740/ <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 /> El Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously UDeferred <br /> ❑Sending Fire Notes to Project Team 10This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) WSee PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd EA Separate PW Permit is Required(Permit#:PW)16- d4 ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND ►- Is located in this folder <br /> Chemical Sup: ❑Update Existing Chew 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 /> droved 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: ,., IZ C. ` // <br /> 7 Date: ct Izem <br />