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tis <br /> Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# 'l 'l I D27 tO <br /> BUILDING PLANNING Intake OK by: Date: Intake OK bye,11Ii ,,PDate: I. %c 1 ZOt <br /> Intake Comments: Intake Comments: Assign To: • d\ <br /> se u cecUt,r(6, <br /> ❑ Route to Commercial Building ®Attach to Project No.�S Q UV`- \` �v <br /> 0 Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 01OK to Route to Other Departments <br /> BldglTl/Addn/Rem Size 13 '�'' ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone K- <br /> Number of Stories :±-- Overlay/Agreement <br /> Basement MNo ❑Yes , Fin/Unfin Nonresidential Use t;'\i\U,,CCV <br /> Type of Construction V- P✓ Residential Use <br /> Occupancy Group k Proposed No. of Dwelling Units: <br /> Occupancy Load (=t35 Total No. of Dwelling Units: <br /> Fire Sprinklers: ®Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes pNo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: alUpdate Existing ONew 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 ® No DEverett School Di ❑Mukilteo School Dist <br /> Add.'RCW 64.55 docs required prior to final? ❑Yes 0 No Additional Notes: <br /> VALUATION CALCULATION: Total $ 2, D3'43 ODD <br /> Approved By:C______&'' Date: _QN-,2O\\ <br /> PUBLIC WORKS <br /> Intake OK by: V. / Date: 49?/ f/ <br /> Additional Notes: Intake Comments:- s' '0�p� PW Worksheet Needed if: <br /> ` J 2 I l ❑Sys Dev Eval ❑Traffic Mit Eval <br /> •t✓4 Site Work or Drainage Proposed <br /> biza-�„ Ib' <br /> 39.A.'L ❑Backflow Prevention for high hazard: <br /> Approved By: �,�Q� Date: [n/291(ot �, J <br /> (J` �,X/w-- (dental,medical,animals,mortuary,hospital, <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 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) ❑ See PW Review Worksheet and associated attachede items <br /> Fire Sprinklers: ❑Update Existing Mew System 0 Not Req'd R A Separate PW Permit is Required (Permit#: PW `1 O -O ('\ ) <br /> Fire Alarm: ❑Update ExistinglaNew System 0 Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd R Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: <br /> 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ADD FIRE FEE ❑ NO FIRE FEE 0 Public Works has no scope---PW Not Required <br /> Approved By: 1�.517i Gz�,1') Date:47---,.2 , /7 Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: \ Date: 1 t ) "J 11 L <br /> Zr I <br />