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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 11\A t 0 V' 0[5 <br /> • BUILDING PLANNING <br /> Intake OK by_3i/, Date:(W,g/O7/�kS Intake OK by0 Date: - - Z0\2 <br /> Intake Comments: Intake Comments: Assign To: �c <br /> rrN :toute to Commercial Buildings,M) 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit t&OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone ,y,- <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 ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes MNo <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? DYes 0 No ❑Everett School Dist ❑Mukilteo School Dist. <br /> Add'I RCW 64.55 docs required prior to final? 7❑Yes 0 N Addi 'oval Notes: <br /> VALUATION CALCULATION: Total$/3 •dv O ii <br /> \ P-Q1 1kwt i,M,,�'1^\\AMVIV', Sc4'Qi <br /> Approved By. -) Date: VQ, \ _2J! \i" <br /> ` PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By' Datery//g//�Q ❑Backflow Prevention for high hazard: <br /> I (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE,DEPARTMENT El 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 /> El 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)pa� 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ONew System 1rlJ�Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: El Update Existing ❑New Stem I!� Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existin.0 New System Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ii // t Of I 'Et) ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> I <br /> Approved By: Date:__&-(-1{-41436— 0 Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL /.4,1iLi <br /> Additional Notes: ye <br /> Approved By: Date: Approved By: Date: -----;\ <br />