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2CoUt ° Uit' ll-002-• <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY. . PERMIT# G 101 O OD <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> illoake 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 ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 21 p2 [t ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size • Lill P Zone <br /> Number of Stories 2.- Overlay/Agreement DO <br /> Basement INNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group ZtA) Proposed No. of Dwelling Units: I <br /> Occupancy Load Total No.of Dwelling Units: I �,/ <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? DYes IeNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑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 El Everett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes�i ❑No Additional Notes: `'—'--" <br /> VALUATION CALCULATION: Total$ 2-65 1 32,tri)i <br /> • 2015 I V--.G 4 W G0 <br /> Approved B "- Date: q5igoll <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 /> ❑Site Work or Drainage Proposed <br /> Approved By: dtIL Date: / !6/1Q ❑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) DThis 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 N.This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) '7 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DUpdate Existing Chew System ❑ Not Req'd ZIA Separate PW Permit is Required (Permit#: PW ROS-0)g ) <br /> Fire Alarm: ❑Update Existing ❑New System ❑ Not Req'd AND k= Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder coin with this folder for permit issuance) <br /> Additional Notes: ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> oproved By: Date: 0 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: f / <br /> Approved By: Date: Approved By: Date: 8/q/7g-i(.t <br />