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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# \scU -O 4 Lt <br /> BUILDING PLANNING <br /> Intake OK by: / Date: o/,art B Intake OK by: Date: <br /> Intake Comment . 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 /> Bldg fthAddn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone <br /> Number of Stories f Overlay/Agreement <br /> Basement ❑No Mes , Fin/Unfin Nonresidential Use <br /> Type of Construction IL- Residential Use <br /> Occupancy Group - 4-/13 Proposed No. of Dwelling Units: <br /> Occupancy Load Z gg Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing El New System t4Not Req'd Planning/Landscape In-section Required before Final? ❑Yes ❑No <br /> Reason Sprinkles Required: -41- "%,„tg,"7--.F4,„,-T° 'Pm "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ID New System ❑Not Req'd School Impact Fez. Total $ <br /> Reason Fire Alarm Required: -E,,6,s-rt 1-0, Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett S, ool Dist ❑Mukilt S ool Dist <br /> Add'!RCW 64.55 does required prior to final? ❑Yes No Additional otes: 1 <br /> VALUATION CALCULATION: Total$ ?�Oj 0 <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> Intake OK by:_ Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> -RPVCD 5Lti Vcra.s <br /> ❑Sys Dev Eva! ❑Traffic Mit Eva! <br /> DSite Work or Drainage Proposed <br /> Approved By: Date: 1, + ❑Backflow Prevention for high hazard: <br /> '�I (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 ❑ 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: ❑Update Existing ❑New System Not Req'd ❑A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ,Update Existing ❑New System ❑-I Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System �E 1 Not Req'd ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: Uj) , I P 641 pi( 5( ,�„S �, 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ,/ -2,/.7-- Date:,,/,/ /ff ►%�� Public Works has no scope PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> (........;-12„) <br />