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Intake &Approval Sheet (FOR0 PERMITSTAFF ONLY) BldgE IT# Vb($ '6 --.7 <br /> BUILDING PLANNING <br /> Intake OK by: Date: 102# ( 10 Intake OK by: ___-;‘l Date: \.2, 2. *,•.2-‘2A'r <br /> Intake Comments: Intake Comments: Assign To: \ 'v��-P,\.A <br /> ❑ Route to Commercial Building 0 Attach to Project No. sevA\- -C \c\ <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> El-Make this a"W"Permit 'OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size -5-4, a°t9- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size : ,— Zone <br /> Number of Stories k Overlay/Agreement Y t 0 n Cj <br /> Basement No ❑Yes , Fin/Unfin Nonresidential Use {f1,b n ej <br /> Type of Construction \(- Ft Residential Use M 1-H-f' Yvi 1 <br /> Occupancy Group p= 2 Proposed No.of Dwelling Units: �j 2 <br /> Occupancy Load 1(00 Total No. of Dwelling Units: 20 on �i,,—�,// <br /> Fire Sprinklers: ❑Update Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? LMYes El No <br /> Reason Sprinklers Required: -22pJPs "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing Ib1New System ❑Not Req'd School Impact Fee: Total $ '`5 Q..0.0 -' <br /> a <br /> Reason Fire Alarm Required: t Calculated:,5ly N 13,23O•'' Credit:(\> -3, NO.°" <br /> RCW 64.55 MF worksheet req'd for permit? Yes DI No %4 Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? I��DiS,.lYes ❑No Additional Notes: �gc..&Cr•1'Cj PIG!linen/}. /f'15/. a4 O f) <br /> VALUATION CALCULATION: Total$ 4, 2(as ''$6 / „lf a, a't - v(4'& - y�l r/O{ j U"[�'O!/CO, <br /> Ca , Qc 3 ( 1\�-)= 4 , z cae.) �a tx /� / / <br /> Approved — Date: V/ 30//7 <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: Date: (.e f -I ig ❑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) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ['Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team Til This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 121See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing L_INew System ❑ Not Req'd ig A Separate PW Permit is Required (Permit#: PWISO?—OI, ) <br /> Fire Alarm: ❑Update Existing la New System ❑ Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ig Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: <,8 re3 vv fJ Date: &/0 G 7 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By:G Date: -I-17Am --_, <br />