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Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLr • PERMIT # <br />BUILDING. <br />Intake OK by: Date: 6? Z <br />Intake Comments: <br />❑ Route to Commercial Building <br />PZ Route to Residential Building <br />❑ Make this a "W" Permit <br />OiDTI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />4So 2-1 <br />Number of Stories <br />Basement <br />KNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Q U <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br />Add] RCW 64.55 docs required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $ Z-O?::, 70 1 <br />Additional Notes: Z<:N5— /PC 0- WsleV <br />Approved By: Date: /Z <br />FIRE DEPARTMENT <br />Intake: (Needed for Townhomes, Alley load SFR, New Commercial) <br />❑ Route to Fire Drawer --- Fire Preliminary Review Notice <br />El Sending Fire Notes to Project Team <br />Date: (OK to Route to Other Departments) <br />Fire Sprinklers: []Update Existing ❑New System Not Req'd <br />Fire Alarm: ❑Update Existing El New System Not Req'd <br />Chemical Sup: ❑Update Existing ❑New System Q Not Req'd <br />Additional Notes: <br />Approved By: Date: 31 J <br />f / <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by Date: 7-0`g <br />Intake Comments: Assign To: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />IWOK to Route to Other Departments <br />Hold in Planning File Drawer <br />Zone <br />_ <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Q)A •2 <br />Total No. of Dwelling Units: <br />04\-2 <br />Planning/Landscape Inspection Required before Final? ❑Yes ®No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $y'o_Qo <br />Calculated: Credit: ►1©A-e. <br />®Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />Approved By Date: <br />PUBLIC WORKS <br />Intake OK by: -rTZr4 Date: 112.4 i t ,% <br />-----T --- ------------- --- <br />Intake Comments: ;PWWorksheet Needed if.• <br />p4evj sicx ow J R�.s-r Sys Dev Eva] Ll►�Traffic Mit Eval <br />AffSite Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />$P��►tta 'gLot K S �0 1E ; (dental, medical, animals, mortuary, hospital, <br />t 15,—m-- top. :supportive housing) <br />®Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />7-1�-A Separate PW Permit is Required (Permit #: PW l! i2" C> t ) <br />AND 0 Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folder for permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />[Approved B Date: 12—r3 ' lei 9 <br />Z <br />