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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 615:10A OC(1/4., <br /> BUILDING PLANNING <br /> Intake OK by:c.)1 Date:0 7 0//M/ Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ,e 7t- 70 DA, <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 e/R m Sizeja 1 J Z SF 0 Hold in Planning File Drawer <br /> Garage/4essoj1 truct.Size `71.0 SP. Zone R-1 <br /> Number of Stories / Overlay/Agreement <br /> Basement RNo ❑Yes , Fin/Unfin Nonresidential Use ����� <br /> Type of Construction I/4 Residential Use di fie" <br /> Occupancy Group /0— 3 Proposed No. of Dwelling Units: <br /> Occupancy Load 6 Total No. of Dwelling Units: I—, <br /> Fire Sprinklers: ❑Update Existing ❑New System loot Req'd Planning/Landscape Inspection Required before Final? ❑Yes FNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amo <br /> Fire Alarm: ❑Update Existing ❑New System KNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: C dit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Et No El Everett School Dist ❑M teo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes MINo Additional Notes: 1.. t) clAmovbi j �t t/ <br /> VALUATION CALCULATION: Total$ 1°)07S1.20 'o <,,c;'I - (AAt.PJ'NS 0 �djt1 M (I.'! SG GPO".-GP <br /> Approved By: A IDate: 1.1—Il <br /> BLIC WORKS <br /> Intake OK by: -s Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: AfeAre <br /> ryyutj .ttej,z jp&Iark <br /> `, Sys Dev Eval ❑Traffic Mit Eval <br /> YKJ ❑❑Site Work or Drainage Proposed <br /> Approved B v A /4,4 Date:O,4/2'9/ , vU,qft0 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> \ supportive housing) <br /> N FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/ 2= erred Submittals Required: DThis project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinkle ❑Fire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans-N v FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO "E E FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O Review/Inspection Scope-ADD F -E FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: `• <br /> Approved By: Date: Approved By: A-Fi Date: .71 1 I ioN <br /> 2 <br />