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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# j ( '( 0--N <br /> BUILDING PLANNING <br /> Intake OK by�,.ni<. Date:i/D/ /YS Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> 0 Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this " it 0 OK to Route to Other Departments <br /> j <br /> Bldg/9/Addle 0 Hold in Planning File Drawer ((ccv <br /> Garage/Accessory Struct. Size Ail Zone AU\ <br /> Number of Stories Overlay/Agreement --- <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction /A Residential Use <br /> Occupancy Group B Proposed No. of Dwelling Units: <br /> Occupancy Load k,�®fP Total No. of Dwelling.Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ®Not Req'd Planning/Landscape Inspection Required be re Final? ❑Yes ❑No <br /> Reason Sprinklers Required: itoDart "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: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist DM ilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total `� Soo, 80 00 eifonsm of 60\sw52_ cA� kAsk ` 3-12-4 <br /> Approved By:(-------7.5 :7Date: `(.)_Q/S-._2_0\T <br /> PUBLIC WORKS <br /> Intake OK by: —0 Date: 1015 II 8 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> 1,a-ceR.,at_ TI 04.3L7' ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved Date' cf % ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> 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 ❑New System at Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alar date Existing ❑New System Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing 0 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•<;,/:„__ 7 , Date: J JJc/i ' I'`-Public Works has no scope--- PW Not Required <br /> Additional Notes: 4 4„/a/151 <br /> ELECTRICAL /( <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />