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0 n �f <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ` V gels <br /> •,COS <br /> BUILDING PLANNING Intake OK by: Date: c1/2e/18 Intake OK by: N\ q Date: I-� ,16' <br /> Intake Comments: Intake Comments: Assign To: ,vt IQ\6 l• <br /> 6x i O(, e rt ok.c, ace, vat o KILL) 011/4 4.- <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> IR Route to Residential Building Route to Historic Reviewer <br /> Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn 'Vi .ize 5-00 .5-,, ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone `r -77 <br /> • <br /> Number of Stories rrrvtt Z 094141.. Overlay/Agreement (AA ',)[.kr e -Grand I-1,O, <br /> Basement ❑No ICtYes , in)Unfin Nonresidential Use O <br /> Type of Construction Residential Use ✓r i7s-C le-1-1,A 5FK <br /> Occupancy Group Proposed No.of Dwelling Units: 1'30 Fk-6>o tit p }-t. <br /> Occupancy Load Total No.of Dwelling Units: 1 Tinii-L.-- <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes ZiNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ W,J/"1 <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 'No DEverett School Dist DMukilteo School Dist }� <br /> Add'I RCW 64.55 docs required prior to final? DYes �No Additional Notes: N 0 " .<r. --C2,(.,4.)n- VJ L 14- 1>20POS 2 <br /> VALUATION CALCULATION: Total$ 47300 NO I-4.O< Circ_ C.-(Li` IiSL 6►J v L,' - ) <br /> �u�av,f2 . <br /> Approved By: _ Date: '0/2-/z. f 6 <br /> PUBLIC WORKS <br /> Intake OK by: hA- Date: °{/Zg/Zip` <br /> Additional Notes: ZO /5 //Z,L et W SEC Intake Comments: PW Worksheet Needed if: it/dlNJ <br /> rif`SA r -n A t_ BS,L1 Act ���,� G, ,, *J ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Imo+ # U�1 1�, ❑Site Work or Drainage Proposed <br /> Approved By: Date: ( "2 9 1$ $ain e - 1s�12a�r�G ❑Backflow Prevention for high hazard: <br /> L I (dental,medical,animals,mortuary,hospital, <br /> 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 /> El 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) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: DI Update Existing ❑New System ❑ Not Req'd ❑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: 0 Update Existing ❑New System ❑ Not Req'd ❑ Is 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: Date: Public Works has no scope---PW Not Required <br /> Ad itional Notes: <br /> ELECTRICAL <br /> Additional Notes: / <br /> Approved By: Date: Approved By: . 4 . Date: ,' /�gb�r <br />