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Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# n O c -O( I <br /> ,�j BUILDING PLANNING <br /> Intake OK byte/ /, Date: al/fid/ o7°f 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 10 Z.RP 0 Hold in Planning File Drawer <br /> i <br /> Garage/Accessory Struct. Size — Zone (, � ,4. <br /> Number of Stories ILL 4- Overlay/Agreement <br /> Basement 4N ❑Yes , Fin/Unfin Nonresidential Use plF1(,Q, — (,2-,4,05 <br /> Type of Construction — ,g Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load 11--'27Total No. of Dwelling Units: Z.........". <br /> Fire Sprinklers: ❑update Existing ❑New System DdNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes imNo <br /> Reason Sprinkles Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: Aril Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cre ' . <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mu ' eo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0 No Additional Notes: � <br /> I ha-en� c��- on� n0 �e�c�o <br /> VALUATION CALCULATION: Total$ C`vw4 , ,r vo.6 . t;,� 41,„-, ,atrxt\— <br /> Approved By: .W.,,6\ Date: 1,�10.�1 Cl <br /> U <br /> PUBLIC WORKS <br /> Intake OK by: T . _Date: l J l D I 19 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> p <br /> ,i-r - - b ft- rt ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> I INTO 'F'W Scope_ <br /> Approved By: Date: (IZ� t '{ ❑Backflow Prevention for high hazard: <br /> /r1 (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> IRE 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 ® Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ONew System .® 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: ijtej row II e„/ - �►1.-/el 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: C,�orjL•1_ ?if-Date: (-1.s'- 19 Public Works has no scope---PW Not Required <br /> 14ditional Notes: <br /> _ //(o is 9 <br /> ELECTRICAL <br /> Additional Notes: _ <br /> Approved By: Date: Approved By: Date: <br />