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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) •\ PERMIT# 0 1$ 1 a-0 Z' <br /> BUILDING PLANNING <br /> Intake OK by: Date: �>21 1 l 3 Intake OK by: Date: \,2=:t v 2.'\ ',2-O\- <br /> Intake Comments: Intake Comments: Assign To ).6 <br /> ❑ Route to Commercial Building Fia Attach to Project No. sa � -C \c\ <br /> ❑ Route to Residential Building ❑. /Route to Historic Reviewer <br /> ❑ Make this a"W" Permit N OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size s1-'I ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size (439- Zone I <br /> Number of Stories 3 Overlay/Agreement ►l Of-(i <br /> Basement 011No ❑Yes, Fin/Unfin Nonresidential Use {f10 v1 t <br /> Type of Construction V 1 7' Residential Use Nun Ili.tt VVIAI <br /> Occupancy Group l2-.t ' •-a_ Proposed No. of Dwelling Units: U <br /> Occupancy Load 2.f0 Total No. of Dwelling Units: PO3 ioH ,-i• <br /> Fire Sprinklers: ❑Update Existing New System ❑Not Req'd Planning/Landscape Inspection Required before Final? LV�Yest I- <br /> Reason Sprinklers Required: ,l.bG In Lieu"Fee:Type: Amount$ r <br /> Fire Alarm: ❑Update Existing New System ❑Not Req'd School Impact Fee: Total $ Q.Y }LP S0- 'CO <br /> OP 9 <br /> Reason Fire Alarm Required: 6e/�TI Calculated:ISfp '„13,2-..S0 `'° Credit(\> 3, L' .`�" <br /> RCW 64.55 MF worksheet req'd for permit? EYes 0 No gl Everett School Dist ❑Mukilteo School Dist ,a <br /> Add'I RCW 64.55 docs required prior to final? rAYes P,(�-f e -+o Ti/t/Ir1 V t"- 'I7S e44-j Cho Additional Notes: • <br /> VALUATION CALCULATION: Total$ 4 to to,4- 72- t f&7''• oFte.dL,uL 5L Pei cv-1'e I w/ Co. l <br /> (15(8 i- tt.,2.A) 12.1 t (I,434-) 6,0 / <br /> Approved Date: q/;?.. T/j ' <br /> PUBLIC WORKS <br /> Intake OK by: !S 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: 4 r? H �Gj ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENToute 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 /> El Sending Fire Notes to Project Team grThis Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) igiSee PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ONew System ❑ Not Req'd 181 A Separate PW Permit is Required (Permit#: PW ilROcf Ol'( <br /> Fire Alarm: ❑Update Existing figNew System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd ❑l Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: 1aWill be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: <, SLcJ}'i Date: -/8 /? ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: AF,1• Date: <br />