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Intake &Approval Sheet (FOR PERMIT STAFF ONL1•� PERMIT# % Sot '�� <br /> Y S <br /> Intake OK bDate:0170-S/Z.o/9 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 /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size s2 r, 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size — Zone -M <br /> Number of Stories - Overlay/Agreement <br /> Basement [FINo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction 3"'e..' Residential Use <br /> Occupancy Group 1 . , g-2 Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: roUpdate 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 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: t,AQ/ LiD0AV i (lo <br /> VALUATION CALCULATION: Total$ a ( Oe-k. 6 L3 r L3 NA-- <br /> Approved By: f�. Date: 2,-(6--11 <br /> -41C Wp1W <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date: D I�j ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> r , FIRE'DEPARTM NT ❑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 ❑New System 0 Not Req'd 0 A Separate PW Permit is Required(Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ONew System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: 0 Update Existing 0 New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: <br /> ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> ❑ ADD FIRE FEE F NO FIRE FEE [X Public Works has no scope---PW Not Required <br /> Approved By: k. e312,(,./r Date: a -/...2/9 Additional Notes: <br /> .;.. .. EL ECTRICA1. ,:, . <br /> Additional Notes: _ <br /> Approved By: Date: Approved By: 7�)‹ttCt Date: 2 (Ft) <br />