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ttp l8[o- ©o IC'� b`, dZ <br /> ti <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONL PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> rake 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 1-15q i$ 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size L121 01 ZoneW 1 <br /> Number of Stories 2- Overlay/Agreement j DC) f D iJ <br /> / <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use ' w' - <br /> Occupancy Group yZ,I tiki 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 IJ No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$/ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ -.� pee-id, <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 �1-i 6)12-02,°� <br /> iLDIcJ ' G w ou Approved B .__�___ J t Date: V/R1/7 <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 /> OSite Work or Drainage Proposed <br /> Approved By: c Date: //)///, ❑Backflow Prevention for high hazard: <br /> (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 IZI This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) C4 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd 14A Separate PW Permit is Required (Permit#: PW IgO1-Ot39" ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND '"14 Is 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 /> 0(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: AFQir Date: I--16-7 q <br />