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rb <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ` 1 02e DO <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by. \PDate: <br /> fL• kq zo% <br /> Intake Comments: Intake Comments: Assign To: • O\ <br /> sp u re.CtUli`t& <br /> ❑ Route to Commercial Building IN Attach to Project No. S` y`\ `` C)c � .---- <br /> O Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit LOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 13 S�-' 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone V- <br /> Number of Stories i.-- Overlay/Agreement \\� <br /> Basement mNo ❑Yes , Fin/Unfin Nonresidential Use �'�Uk,.C�,V� <br /> Type of Construction V- 6 Residential Use <br /> Occupancy Group k- 3 Proposed No. of Dwelling Units: <br /> Occupancy Load f 1. Total No. of Dwelling Units: <br /> Fire Sprinklers: ®Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes giNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: aClUpdate Existing ❑New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RC nteautr, e/ 0)s( No ❑Everett School Di ❑Mukilteo School Dist <br /> Ad. i„�� No Additional Notes: <br /> VA cr el6t4S cXl <br /> 55/-1 l 2 i 9 a do of, :/9 (1 <br /> &frit ii if //�y� Approved By Date:-1—QC,2cJ\-1 <br /> I1E ViSyreW ` Cllt/� ck PUBLIC WORKS. <br /> ``�- f`f 1 cam" Intake OK by: /?1. Date: 9 / /`7 <br /> Ad( II;£ L Intake Comments:I/We& fyiyel PW Worksheet Needed if: <br /> `�� b2 <br /> VI <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 4Site Work or Drainage Proposed <br /> S r�(I Act-cif <br /> E�TLou-�-a/ El., <br /> Prevention for high hazard: <br /> AK A,- .• (dental,medical,animals,mortuary,hospital, <br /> end --_P.__� <br /> �r d� 1 end Route this folder for PW Review at --PW Review Worksheet <br /> ❑This project also has a separate concurrent PW Review(Green Folder) <br /> IO NTI �117 <br /> Ja. <br /> ice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑: /.CL slob 0 This Permit is Approved by Public Works <br /> Dat ts) 0 See PW Review Worksheet and associated attached items <br /> Fire (,id 4rJhaiO/ Y eq'd Q A Separate PW Permit is Required (Permit#: PW ICI n"O '-k ) <br /> Fire eq'd AND 0 Is located in this folder <br /> Che S�t =q'd © Is in a Separate Green Folder(Join with this folder for permit issuance) <br /> ko.„4-E.,---t-Acta,s- <br /> r/" <br /> Addi tx / J � �� 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> .m EA- 5C 0 Public Works has no scope--- PW Not Required <br /> App. oy, A., 1►t e--c.2)'l Date: — / - 1 Additional Notes: <br /> ... . . .... .. . ... . .. <br /> ELECTRICAL <br /> Additional Notes: I ' <br /> Approved By: Date: Approved By: ;'/Av 1, A Date: 1 I; v-) Ilf/ I „ <br />