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Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# .' ' I\g cot--02A <br /> BUILDING PLANNING <br /> Intake OK by: Date: 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 y Lt. <br /> Number of Stories Overlay/Agreement fe046WAart Cargka," ' <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ONot Req'd Planning/Landscape Inspection Required before Final? ❑Yes)No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amou <br /> Fire Alarm: ❑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 ❑Muki o School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: g/, <br /> K-„�an OM-5 <br /> 1 _ <br /> VALUATION CALCULATION: Total$ /7000.00 <br /> O �+ 1W-e- <br /> Approved By: Date: q. 1Z, i q <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed <br /> ❑Sys Dev Eval P raffic Mit Eval <br /> ❑Site Work or P ainage Proposed <br /> Approved B� '�lly�✓� Date:®7//27/r�i9 ❑Backflow evention for high hazard: <br /> (dental,m-•,ical,animals,mortuary,hospital, <br /> suppo; housing) <br /> - <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at d PW Review Worksheet <br /> Separate/Deferred Submittals Require•• ❑This project also has a separateoncurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm r24 Other: AND ❑Create Green Folder 2 Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approver.y Public Works <br /> 0 See PW Review Jrksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate P -'ermit is Required(Permit#: PW <br /> ❑ Review of -Built Plans-NO FIRE FEE AND 0 Is I• ated in this folder <br /> O Minim• or No Fire Scope-NO FIRE FEE 0 in a Separate Green Folder(join with this folder for permit issuance) <br /> O R- iew/Inspection Scope-ADD FIRE FEE ri Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 'ublic Works has no scope---PW Not Required <br /> A-ditional Notes: <br /> ELECTRICAL. '/�d� 1 <br /> Additional Notes: , V (Li <br /> Approved By: Date: Approved By: Date: <br />