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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#S2j\90 ~005 <br /> �} <br /> , BUILDING PLANNING <br /> Intake OK by: cdt Date: //�C/!' Intake OK by: Date: <br /> Intake Comments: 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 /> 0 Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ((p a 5.e Zone 2,-2 <br /> Number of Stories ( Overlay/Agreement <br /> Basement al No ❑Yes , Fin/Unfin Nonresidential Use 11 <br /> Type of Construction Residential Use ( QiYV1,Q1 SFf'N <br /> Occupancy Group W Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: 4...- <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes in No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ ..._,....-- <br /> Fire <br /> �fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ t� <br /> Reason Fire Alarm Required: Calculated: Cwt <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No ❑Everett School Dist cimukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes gNo Additional Notes: 15 cove.-eel% Ate- 2 Ycinau- <br /> VALUATION CALCULATION: Total$ 4 2D 0 'P'61.4" ' cx.' k0 F/Z ; ‘Dektexcks fy044.ei J iiQ,�,plig5,,}- <br /> ((v8@ 25) A)(1,51G�- r vtreel r, - VD i-dt - ,n, ' t-- <br /> Approved : 4, ok Date: 1-Li.-11 <br /> PUBLIC WORKS <br /> Intake OK by: —1-0-\ Date: i 4.4 /2_019 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if:: <br /> 2.. 1.,1_ti- "0€ L,!--s ❑Sys Dev Eval ❑Traffic Mit Eval <br /> p,- s / (o SF ❑Site Work or Drainage Proposed <br /> Approved By: ejtt, Date: //. y//9 -�t,' ❑Backflow Prevention for high hazard: <br /> �vJ s a oc c,BjT (dental,medical,animals,mortuary,hospital, <br /> A.-c - _s. --ro 8 .c,c, supportive housing) <br /> FIRE DEPARTMENT gtoute 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 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: ❑Update Existing ❑New System 0 Not Req'd ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 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: Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: , -- Date: 1 I 91)2,6i9_. , <br />