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S <br /> Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# t J -O <br /> BUILDING PLANNING <br /> Intake OK by:_____dit_ Date: 67Zo//e Intake OK by: 4,a- Date: c-2o-ig <br /> L <br /> Intake Comments: Intake Comments: Assign To: ith <br /> 6142d it re,he•,) r &ornmnce L)l CLA ri-cicar¢ �. <br /> co Scor\D f loa- r97s,eci _ i40,04 A relitrw4-`' Co„w <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> Egt Route to Residential Building ❑ Route to Historic Reviewer ElMake this a"W" Permit OK to Route to Other Departments 0 Lt 124 <br /> COTI/Addn/Rem Size 32 74 S • ' Drawer <br /> Garage/Accessory Struct. Size 3 0 F Zone <br /> Number of Stories 3 Overlay/Agreement <br /> Basement VitNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use �n,J\- Y L) <br /> Occupancy Group u Proposed No. of Dwelling Units: Z. <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 OW thi <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $. oZ�D )C G% ��-A <br /> Reason Fire Alarm Required: C culated: Credit: ,I \ipRCW 64.55 ME worksheet req'd for permit? ❑Yes ElNo Everett School Dist ❑Mukilteo School Dist t • <br /> \ � <br /> Add'I RCW 64.55 docs required prior to final? Oyes ❑No Additional Notes: Arpves? <br /> QS t�k;� _ <br /> VALUATION CALCULATION: Total$ 424, f- ;�57 � <br /> Approved By: h, i q Date: (Q )4.n <br /> PUBLIC WORKS <br /> Intake OK by: .J Date: 8 40 /1 e, <br /> Additional Notes: 2 0/S /ZC, (A>S�C Intake Comments: PW Worksheet Needed if: <br /> LA-SS ?1*A.'$ 'L,0O 3'' RiSys Dev Eval giTraffic Mit Eval <br /> "`1 i"0 I"4 P. Site Work or Drainage Proposed <br /> Approved By: Date: 0? ?La ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> elZ4 ' 1/t '/t't c-c ,. rA p,/(1ono_ , 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 U 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 14 Not Req'd ❑A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New System FJ Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 10,Not Req'd ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: 1 ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:5&) � / _ Date: lip///� El Works has no scope PW Not Required <br /> "`'��� /5 Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: t <br /> Approved By: Date: Approved By:*,�''` Date: iO '20l, <br /> '/y <br />