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'5q) - 08)(61D- 00Z C _ <br /> Intake Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT# " OOb <br /> BUILDINGPLANNING <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 I� OK to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size '1) 0 col t 0 Hold in Planning File Drawer <br /> C <br /> Garage/Accessory•Struct.Size 7g.1 Cli Zone WO <br /> Number of Stories 2.. Overlay/Agreement Niel.(-,€ MAIN <br /> Basement igINo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use j -12----' <br /> Occupancy Group l Rd Proposed No.of Dwelling Units: I <br /> Occupancy Load Total No. of Dwelling Units: ( Ne <br /> Fire Sprinklers: ❑Update Existing [hew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes L1?No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: CI Update Existing :New System ❑Not Req'd School Impact Fee: Total $ <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? ❑r Yes f❑No Additional Notes: <br /> rLUATION CALCULATION: Total$ �j 63 ,1 (0a®OO <br /> 9,D' l 12-ti Wce& Approved By: Date: ,1 13/14 <br /> PUBLIC WORKS 1 <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval OTraffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By: cjiti Date: Z(oG <br /> ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT El 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 ODeferred <br /> ❑Sending Fire Notes to Project Team g 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 2A Separate, PW Permit is Required (Permit#:PW ITQ5-0.55 ) <br /> I�1 <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND is located in this folder <br /> Chemical Sup: ❑Update Existing 0 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 /> improved 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: ....A5-4- Date: 0,A5/701,91 _______,,, <br /> (714 <br />