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Intake &Approval Sheet (FOR PERMIT STAFF ONL1� PERMit# lg '-072 <br /> • BUILDING PLANNING <br /> Intake OK by: Date: Intake OK Date: q/1/0/tir <br /> Intake Comments: Intake Comments: Assign To: T we-10104 <br /> meted A� v�� baa, <br /> /6 !/ / 1r <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 IOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ONew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes L1 No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑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 0N Additional Notes: C7znicd. (-0`(1-1W•074 �{ <br /> VALUATION CALCULATION: Total$ 1015 I1/40 3R! <br /> Approved �'"" Date: fl i 1 / f <br /> PUBLIC WORKS // <br /> Intake OK by:1iz_J Date: `?/'o J I <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> py t tBo%-0-i2 ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 4LR>LA'pv 8.4 fet-REV t -& DSite Work or Drainage Proposed <br /> Approved By: J 7 Date: 100/� ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ItRoute 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 EkThis 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: ❑Update Existing ONew System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PWIS - o?2—) <br /> Fire Alarm: ❑Update Existing ONew System 0 Not Req'd AND ® Is located in this folder <br /> Chemical Sup: ❑Update 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved B .p�jj��ry��C4 Date: AV/SA <br />