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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ('V) L&J3 'O <br /> BUILDING . ,. , PLANNING �i <br /> Intake OK by: iter Date: I j Intake OK by. Date: I�ie:l/a <br /> Intake Comm zit : Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit a-OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone IVV' "2, <br /> Number of Stories Overlay/Agreement MGi f r.Z.-p/ <br /> Basement El No ❑Yes, Fin/Unfin Nonresidential Use f eM4L-6r.ali fif/I71 <br /> Type of Construction Residential Use <br /> ----ter. U <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 I No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New 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 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: .- <br /> VALUATION CALCULATION: Total $ <br /> Approved Date:O/C7/7/g <br /> PUBLIC WORKS <br /> Intake OK by: Date: � � �,�(.g <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> Approved By: <br /> Nt lawG�� <br /> Date: elf �te _' ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> f <br /> ❑Backflow Prevention for high hazard: <br /> �V`. � (dental,medical,animals,mortuary,hospital, <br /> 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 El Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 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 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing El New System ❑ Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New 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: -XPublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL' <br /> Additional Notes: , '( \I <br /> Approved By: Date: Approved By: ,40 .,r` Date: 8/07'/ g <br />