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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# V l'/V ' Ot I <br /> BUILDING PLANNING <br /> g Zola <br /> Intake OK by:�:�, Date: �.8/©Z�Zo� Intake OK by: d ` Date: I 31141.4fSai <br /> Intake Comments: Intake Comments: Assign To: Qu h <br /> CQc5 4/ar PaplroEO a/rdirE. ra se <br /> Rlairtaco BY Po2r, <br /> ;Route to Commercial Building ❑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/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update 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? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist. <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ <br /> Approved B : Date: Z1h <br /> PUBLIC WORKS <br /> Intake OK by:_M�1. Date: g/2120/$ <br /> Additional Notes: Inta ka Comm nts: L PW Worksheet Needed if: <br /> only /) look?iv, a2 ❑Sys Dev Eval ❑Traffic Mit Eval <br /> CAV►f Plana mtn laSite Work or Drainage Proposed <br /> Approved By: Date: g� if, etbl!`><y it tpr- ❑ a, flowmedical, <br /> Prevention for high hazard: <br /> ..4/ (dental,medical,animals,mortuary,hospital, <br /> Y2/7 <br /> re__ /10 JE!VltW AC Wee supportive housing) <br /> FIRE DEPARTMENT DRoute 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 EiCreate Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sendin Fire Notes to Project Team X This Permit is Approved by Public Works �Gr bui/ding p ,mrf' <br /> Date: g (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items N/Pt <br /> Fire Sprinklers: ❑Update Existing ❑New System .t Not Req'd NIA Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New System Jgt Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: 0 Update Existing 0 New System gNot Req'd tgIs 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:kJ 3— Date: gl7`4 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: . <br /> Approved By: Date: Approved By: AS' Date: gl o2/_oig <br />