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25 0 -0)-1-66- gs I (o- col /'' <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# v l"b l --O I <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 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 1-15°1 a 0 Hold in Planning File Drawer nn <br /> Garage/Accessory Struct.Size 1-111Zone 'Y v C <br /> Number of Stories 2— Overlay/Agreement ?DO t DA <br /> Basement IT4No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction 5Th Residential Use S R- <br /> Occupancy Group IQ lk 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 tyNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ '-te55 pc <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!RCW 64.55 docs required prior to final? ❑Yes 0 N Additional Notes: <br /> VALUATION CALCULATION: Total$ y G,2O1.Da <br /> 2D15 1126 1 Wg SCJ1 i Approved B : Date: t i b )9 <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 /> Mite Work or Drainage Proposed <br /> Approved By: ditDate: V.210 9 <br /> /2 /i9 ❑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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 15it This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) aSee PW Review Worksheet and associated attached items / <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd RA Separate PW Permit is Required (Permit#: PW 156/'-'13q6 ) <br /> Fire Alarm: ❑Update Existing Mew System 0 Not Req'd AND tit Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder Goin with this folder for permit issuance) <br /> Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> IHproved By: Date: 0 Public Works has no scope---PW Not Required <br /> II II Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: ck Date: 1_Ig.-z019 <br />