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0 <br /> 1110 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# b( /D-OI 2' <br /> BUILDING / PLANNING <br /> Intake OK by:. ,Ioi.e Date/a/03 20/4 Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> BId /TI/ ddn/Rem Size 3 JO SP 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 4./.,/ Zone S A_U <br /> Number of Stories 3 Overlay/Agreement T <br /> Basement pNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction T A Residential Use <br /> Occupancy Group 5 Proposed No. of Dwelling Units: <br /> Occupancy Load ,JSS Total No. of Dwelling Units: <br /> Fire Sprinklers: ®Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Requir-• •- ore Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I:3 No El Everett School D . ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 123No Additional Notes: <br /> VALUATION CALCULATION: Total$51Z.I S0,O D 1)03 e gg 04 6 <br /> 04 kilt- fre\f°le-4 <br /> Approved By:( , ' Date: \,Q,OS Zo\$' <br /> PUBLIC WORKS <br /> Intake OK by:'-"M Date: /0/5/12 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> t na-rg.sto a. Tt G fit_' Sys Dev Eval IgTraffic Mit Eval <br /> INO Gr4C►r•1C o uS$ ❑Site Work or Drainage Proposed <br /> Approved By:k Date:D y/c//z�5 rck ec/C 0D1/ 4 OBackflow Prevention for high hazard: <br /> v "� "7" (dental,medical,animals,mortuary,hospital, <br /> Olt <br /> supportive housing) <br /> iv* . <br /> FIRE DEPARTMENT gra 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 El Deferred <br /> ❑Sending Fire Notes to Project Team ❑ This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) ❑ See PW Review Worksheet and associated attached items <br /> Fire Sprinklers:gupdate Existing Chew System ❑ Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: jijUpdate Existing ❑New System ❑ Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: 3(;d Date: ,,tsi( Public Works has no scope---PW Not Required <br /> U Additional Notes: <br /> ELECTRICAL l'lo lbJ Z. cASE ie.t 56104-F.f.. Ceo.170,e.•4.— So "Ica <br /> b•tir—C4-As£ i*J 5I'S UEd_ p.e.. T a*ric. .4aftiern4 <br /> Additional Notes: ,/,3c. (i)1 <br /> Approved By: Date: Approved By: Date: <br />