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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# sli3 `ZO <br /> BUILDING ? PLANNING <br /> Intake OK by: �r, Date: Intake OK by:` X� Date: q 0 I Oki( <br /> Intake Comments: Intake Comments: Assign To: C f lC2 9 <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 0 OK to Route to Other Departments <br /> BIdeAddn/Rem Size 69 yz*7 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size .1//�d Zone <br /> Number of Stories / Overlay/Agreement <br /> Basement 5No ❑Yes , Fin/Unfin Nonresidential Use ceS Vc'A _ <br /> Type of Construction (/IQ Residential Use <br /> Occupancy Group 4• Z- Proposed No. of Dwelling Units: <br /> Occupancy Load 2—$Z._ Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes JNo <br /> Reason Sprinklers Required:,XY�S'rrv✓- 51S-rent "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Fxt'Sr 4' cY5T M Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 5i No ❑Everett School Dist ❑Mukilteo School Dist. <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ®No Additional Notes: <br /> VALUATION CALCULATION: Total$ /0(3000.66 c\ ekej c c* kc),Q fevios-QA <br /> ('ES 0.cV6.4 Scp49x <br /> Approved By<"--: (— ) Date: q .3(_ -.z_d\,y/ <br /> PUBLIC WORKS <br /> Intake OK by:"1-11-44 Date: - . <br /> Additional Notes: Intake Comments: PW Worksheet - led if: <br /> ALL. ex„reca.40oL ❑Sys De 'val ❑Traffic Mit Eval <br /> Is ork or Drainage Proposed <br /> .10 ?NO S40,42Backflow Prevention for high hazard: <br /> Approved By: � , Date: //e 0Zo/8 <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder fo Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project al 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 0 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:jElUpdate Existing ONew System ❑ Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: IJ Update Existing ❑New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System .® 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:e r"T Date: ' -/r' (' 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> Z <br />