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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT#�1 ��0 i -0° I <br /> BUILDING PLANNING <br /> Intake OK by: Date: g/ li3 Intake OK by: ' Date: eiC I <br /> Intake Comments. Intake omxnents: Assign To J Lv�S- <br /> vkl- <br /> vr v'l Thejf c ti , 42A)'.15 < <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑%a to Route to Other Departments <br /> Bldg n\ddn/Rem Size \4 woo ► Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone <br /> Number of Stories `L Overlay/Agreement <br /> Basement jKlNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction - Residential Use <br /> Occupancy Group r Proposed No. of Dwelling Units: <br /> Occupancy Load 2_''-ct Total No. of Dwelling Units: <br /> Fire Sprinklers:,Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes> NQ <br /> Reason Sprinklers Required: C--"441-.4fE. c'r--•v('lkl.ICY "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: ?NAu('' cacc-uMau( Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1,2 No ❑Everett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes /VNo Additional Notes: <br /> VALUATION CALCULATION: Total $ S'10 <br /> Approv Date: 8`23/7r5 <br /> 7" / PUBLIC WORKS l <br /> Intake OK by: � Date: R�C f /r <br /> Additional Notes: Intake Comments:t ,,�,� ;PW Worksheet Needed if: <br /> A ,�i i.!1214 `311- , Sys Dev Eval raffic Mit Eval <br /> �1/t,Stri �/y,XG�{ p vc- Site Work or Drainage Proposed <br /> Approved By: / Date: �� I,`�J iS s � ackflow Prevention for high hazard: <br /> .�.)�(qq� x ( ,•$E (dental,medical,animals,mortuary,hospital, <br /> Pew_ T,\ CO: <br /> X il1 S' klE✓S >7 de 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) OThis 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 ISt This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) g See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DUpdate Existing New System 0 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 ❑ Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes:r; ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: yi,C ,,,,g Date: t' E`7-)'r El Public Works has no scope--- PW Not Required <br /> ( / Additional Notes: <br /> `-/ ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: !- , Date: ! I/ <br /> 1 7 1!g -- <br />