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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT# ? ($(a'b43 <br /> BUILDING PLANNING <br /> Intake OK by: o <br /> Date: 42'21 li Intake OK by: Date: \."2- 2'6.,Zr <br /> Intake Comments: Intake Comments: Assign To: Q E)\.&C A <br /> ❑ Route to Commercial Building 1l. Attach to Project No. SE-f-A `lc-C \0\ <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 .}54.1 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size { 4'97 - Zone 0 " <br /> Number of Stories Overlay/Agreement h 0 ae <br /> Basement 'No ❑Yes, Fin/Unfin Nonresidential Use Il pa& 1 <br /> Type of Construction \(— (2' Residential Use .4 -ice l'Y14'!✓ , <br /> Occupancy Group F-- ' , S-Z_ Proposed No.of Dwelling Units: G <br /> Occupancy Load t� 2.(o Total No. of Dwelling Units: 60 �� <br /> Fire Sprinklers: ❑Update Existing al New System ❑Not Req'd Planning/Landscape Inspection Required before Final? LIYes ❑No <br /> Reason Sprinklers Required: ..11'.jG "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ONew System ❑Not Req'd School Impact Fee: Total $ M QY®)(:250-'r' <br /> Reason Fire Alarm Required: 14c. Calculated:VS-1'.x 13.230..2J6 Credit(\> '3,Z' .©V <br /> RCW 64.55 MF worksheet req'd for permit? Yes 0 No %1 Everett School Dist ❑Mukilteo School Dist <br /> ��pII <br /> Add'I RCW 64.55 does required prior to final? I�Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 4-Coto) 4.p¢ <br /> Approved B Date: z'/3o/j <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: ?2?-7 Date: 4pj//lq ❑ a Prevention for high hazard: <br /> 1 (dental, <br /> 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 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) St See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing,Existing klNew System 0 Not Req'd 'A Separate PW Permit is Required (Permit#: PW Igo 9-dill ) <br /> Fire Alarm: ❑Update Existing giNew System ❑ Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ONew System ❑ Not Req'd ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: i<Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:kArinp[,,,A Date: 6- --Ft 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: 7/ _.j 9 <br />