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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT# - 1(3(off-a, ( <br /> BUILDING PLANNING <br /> Intake OK by: Date: 12, t g Intake OK by: C_�l` Date: \,2- \Z.�',Z-(2A'r <br /> Intake Comments: Intake Comments: Assign To: \: v \.e\. <br /> El Route to Commercial Building ►i. Attach to Project No. 5UA c-Civc\ <br /> ❑ Route to Residential Building ❑❑/Route to Historic Reviewer I <br /> El-Make this a"W"Permit L/ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 3[0,2 vCo 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size .. •. - Zone C' <br /> Number of Stories 4 Overlay/Agreement V\O VIZ <br /> Basement ONo ❑Yes, Fin/Unfin Nonresidential Use hU <br /> Type of Construction v- CI Residential Use WWI Vim,IA-t sla NIA I(., <br /> Occupancy Group 'R-Z- Proposed No. of Dwelling Units: (� <br /> Occupancy Load i52- Total No. of Dwelling Units: 'b 3 pin ,�,�..__,,1,� <br /> Fire Sprinklers: ❑Update Existing INew System ❑Not Req'd Planning/Landscape Inspection Required before Final? MYes ❑No <br /> Reason Sprinklers Required: -7 cazx -F-1-1" "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ONew System El Not Req'd School Impact Fee: Total $ `j Q..)d lCP Ste.''`' <br /> Reason Fire Alarm Required: 7 ."24- 4-4"1- Calculated:lS-(p.X l 3,23Q.J` Credit:C\> '1, <br /> t O- <br /> RCW 64.55 MF worksheet req'd for permit? JYes 0 No %44 Everett School Dist ❑Mukilteo School Dist <br /> Add'i RCW 64.55 docs required prior to final? !Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 4-. Ito6, loot° <br /> ( cozolo)'IL ) _ 4 1/41d3 (Qo , <br /> Approved By: Date: - 301 1 -1 <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: 0 Date: t•PI Sjtq ❑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 /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team RThis Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 1ff See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing V/New System ❑ Not Req'd I A Separate PW Permit is Required (Permit#: PW I gO 9-OIL ) <br /> Fire Alarm: ❑Update Existing giNew System 0 Not Req'd AND 0 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: l Wlli be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: 1l,F�1--6t.V`r1 Date: /-)g ja ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: l- Date: 4/Z f R <br /> Z/Z <br />