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'V bD • E B(o- O® l • <br /> Intake , Approval Sheet (FO/! PER,,,IT STAFF ONLY) . PERMIT# C Va Ok' 006 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> . ake Comments: Intake Comments: Assign To: <br /> ® Route to Commercial Building ®Attach to Project No. <br /> ® Route to Residential Building - ® Route to Historic Reviewer <br /> ® Make this a"W"Permit ® OK to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size 9-1, ' 0 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct,Size Lill VII Zone , .s... W G Number of Stories 0--- Overlay/Agreement 700 _ <br /> Basement EA No ®Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use &fj <br /> Occupancy Group !II tk 'Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: 1 <br /> Fire Sprinklers: ®Update Existing ®New System ONot Req'd ,Planning/Landscape Inspection Required before Final? ®Yes siNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ®Update Existing ®New System DNot Req'd School Impact Fee: Total $_____TaLd-----"" <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ®Yes ® No ❑Everett School Dist ®Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? �2®Yes ®No 'Additional Notes: <br /> ;';VALUATION CALCULATION: Total$ I w,o_o2,Dt <br /> • 2DIS 10-Ci i 1/0600 i <br /> Approved Bir. Date: 713It <br /> s_ <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 /> ❑Backflow Prevention for high hazard: <br /> Approved By: it Date: l //L� (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT j ®Route this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Town homes,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 j AND ®Create Green Folder ®Submitted Previously ®Deferred <br /> ®Sending Fire Notes to Project Team This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ®Update Existing ®New System 0 Not Req'd!; EfA Separate PW Permit is Required(Permit#: PW 19OS—Oil ) <br /> Fire Alarm: ®Update Existing ®New System 0 Not Req'd AND p1 Is located in this folder <br /> Chemical Sup: ®Update Existing ®New System ® Not Req'd 1 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 /> ^',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: �� Date: & <br /> pp pp .���I W felb,9 <br />