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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# I)1C101 O' (c_) 97 <br /> f,. BUILDING PLANNING <br /> Intake OK by: Ill Date: (Q/Z3/(a 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 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone ,_ - 1 <1 <br /> Number of Stories ( Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction .-u Residential Use .A 1 'Pam t1 t <br /> Occupancy Group 2. Proposed No. of Dwelling Units: J <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 j2INo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: p Calculated: Credit: <br /> a <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo Sc of Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EtNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 3 12_ F6 ASS <br /> Approved By: �, Date: Ict.,Z3_(5( <br /> PUBLIC WORKS <br /> Intake OK by: Ti Date: 10/Z3 120 t 41 <br /> Additional Notes: ZUI g' IR,C.- 4 ltdSe�C- Intake Comments: <br /> PW Worksheet Needed if: <br /> t,MTF_z.oa- "R-c".►•o+Et- 'TO' ❑Sys Dev Eval ❑Traffic Mit Eval <br /> goets`'i.'-r F"AA%.1'e eg° .&. ❑Site Work or Drainage Proposed <br /> rea* ?A‘11.+fe o6.att�vG. <br /> ' <br /> Approved By: TDate: '(I�jI No 5{5-t4:r_, ..98vEa-o,/.a6+'' OBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT rfr •oute 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 OCreate 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 craNot Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> 'Fire Alarm: ❑Update Existing ❑New System J1 Not 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: Date: A Public Works has no scope--- PW Not Re uired <br /> Additional Notes: ✓� ' <br /> �� 8 <br /> ELECTRICAL / v 2 4!�p� <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />