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0 • PERMIT# fbnai--()1, <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY <br /> BUILDING. PLANNING <br /> Intake OK by: CH Date: 't l/a(eta Intake OK by: ILA. Date: el- 11-11 <br /> Intake Comments: Intake Comments: Assign To: V---.1\tAyi <br /> 9 .. "6 A.00- IA- Fr., COANtr) liA'11 W to .to 19e m <br /> t o Ir�n.. !�.�_c) c� `' ` _ r i•Ccur�.¢c! J.,c[J <br /> ❑ Route to Commercial Building 0 Attach to Project No. r1e- <br /> RRoute to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit g OK to Route to Other Departments <br /> Bldg/TI /Rem Size ef j F ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone K- I <br /> Number of Stories I Overlay/Agreement <br /> Basement OiNo DYes , Fin/Unfin Nonresidential Use Type of Construction Ti3 Residential Use Ad,J lk capniiA 14orr Q <br /> Occupancy Group • Proposed No. of Dwelling Units: /6 <br /> Occupancy Load WA Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System filNot Req'd Planning/Landscape Inspection Required before Final? DYes Alo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount <br /> Fire Alarm: DUpdate Existing ❑New System 01Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes Inot No ❑Everett School Di ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes uatNo Additional Notes: Q M cen fl oivri^- ECG Iq' .ce0 <br /> VALUATION CALCULATION: Total$ �Gi �da0 <br /> s J able 5y_/ <br /> Approved By: Date: `- i 6---11 <br /> PUBLIC WORKS <br /> Intake OK by: 7-14 Date: 9 f rr I t s <br /> Additional Notes: 2 Q /s /X_C_ (QSE-C Intake Comments: PW Worksheet Needed if: <br /> '40 14E 4 ?wNIE as ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Alin)"'•o. `)w Welt i S tl t ❑Backflow Prevention for high hazard: <br /> Approved By: , Date: 11 dt (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT aRoute 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 fElThis 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: DUpdate Existing ❑New System 0 Not Req'd ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: DUpdate Existing ❑New System 0 Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: DUpdate 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 /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved - =" Date: /fir <br /> 1 J2_, <br />