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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 4�\ S1.0 " 0 `S <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑Route to Commercial Building 0 Attach to Project No. 4cWie.\-00V <br /> ❑Route to Residential Building 0 Route to Historic Reviewer <br /> ❑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 Zone c- <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use (aAtt O.) WWF <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 ❑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 ❑No Additional Notes: \-_ <br /> VALUATION CALCULATION: Total $ b%\'Q,r s 04\6, c,O`I\ `\� SMV\, DZ. S 1 on:\(kr 1A <br /> CZ\oC o . 41.11 \;\;\/.1ii At <br /> Approved By: Date: V.Zct. mS.-- <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPWWorksheet Neededlf: <br /> DSys Dev Eval OTraffic Mit Eval <br /> ©Site Work or Drainage Proposed <br /> / Itjell 't) DBackflow Prevention for high hazard: <br /> Approved By: ;(dental,medical,animals,mortuary,hospital, <br /> Date: '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 ['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 Chew System CO Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New SystemNot 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 Date: ) IIP Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved Br 7,, .---,-1-- <br /> -� — Date: r/ /i.d lzGi g <br /> /, <br /> y <br />