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Intake & Approval Sheet • (FOR PERMIT STAFF ONL19 • PERMIT#�(,,J V e%s -00 j <br /> BUILDING / PLANNING <br /> Intake OK by: Date: I /2/ I Intake OK by: Date: \O.22- L( <br /> Intake Comments: / Intake Comments: Assign To: <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 44,4e7--F-EA ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone . - <br /> Number of Stories � (¢'ci..e.".0 41Uav Overlay/Agreement C-&A <br /> Basement Cho Yes , Fin/Unfin Nonresidential Use i(\.CN\.Q.,, <br /> Type of Construction .31 - ' , Residential Use '11 .1-2 <br /> Occupancy Group E. Proposed No. of Dwelling Units: 1\.0&42, <br /> Occupancy Load `t Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ONew System Not Req'd Planning/Landscape Inspection Required before Final? DYes INNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amo -$—' <br /> Fire Alarm: DUpdate Existing ONew System 1731Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes EZ3 No ❑Everett Sc ool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? DYes 1-21No Additional Notes: \\ OC�firoV�' Q <br /> VALUATION CALCULATION: Total$ ��e-, sec �� \S n®'T 2s\-ol\o\�S`n\Aa^O j Q'i` <br /> VV.S2 vn OC 04 \CVc t addesw d .45 ,��1 <br /> Approved By: ' Date: \.(0.ZI__Zr..Ar <br /> PUBLIC WORKS <br /> Intake OK by: -r Date: I of -f 2or8 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if, <br /> t.a,[Ec+-�o� o�`Y ❑SysDevEval ❑TrafficMitEval <br /> ❑Site Work or Drainage Proposed <br /> 04° "PW 5 co7e ❑Backflow Prevention for high hazard: <br /> Approved By: Date: ,��$ (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 Town homes,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 ❑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: DUpdate Existing ONew System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: DUpdate Existing ONew System ❑ Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: DUpdate Existing ONew System 0 Not Req'd 0 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: 01 'ublic Works has no scope---PW Not Required <br /> A•.itional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> `72 <br />