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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# b zok ( - J <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> O Route to Commercial Building 0 Attach to Project No. <br /> 0 Route to Residential Building 0 Route to Historic Reviewer <br /> 0 Make this a"W"Permit I 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 44 2. 44, CI Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone U\(1—\ <br /> Number of Stories gv \Cee-Wesio 4,`o4,\ <br /> Basement ONo . Yes, Fin/Unfin Nonresidential Use �C�v�Sf�O�,�€, <br /> Type of Construction = — ,I:Z Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load �� �`R�' Total No.of Dwelling Units: <br /> Fire Sprinklers: OUpdate Existing °New System '=�Not Req'd Planning/Landscape Inspection Required re Final? DYes DNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: 121Update Existing ONew 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? DYes 152 No ° /Everett School Dist !F DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes 4o Additional Notes: <br /> VALUATION CALCULATION: Total$ 4.4-S,4 z;1%7 <br /> Approved Date: \I____CA_ 2C ZC <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: .PW Worksheet Needed if: <br /> 1 <br /> i°Sys Dev Eval EiTraffic Mit Eval <br /> I..., <br /> OSite Work or Drainage Proposed <br /> /�/ I OBackflow Prevention for high hazard: <br /> Approved By: P � Date: I I 20.Z1 ;(dental,medical,animals,mortuary,hospital, <br /> it Isupportive 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 EISubmitted Previously °Deferred <br /> °Sending Fire Notes to Project Team El This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: °Update Existing °New System O Not Req'd 0 A Separate PW Permit is Required(Permit#: PW ) <br /> Fire Alarm: °Update Existing°New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: °Update Existing New System 0 Not Req'd 0 Is in a Separate Green Folder (join with this folder for permit issuance) <br /> Additional Notes: ` El` Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> A <br /> Approved By: �� �, at: j7 _%, O 0 Public Works has no scope--- PW Not Required <br /> crr Additional Notes: <br /> ELECTRICAL° <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />