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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#r3$901 — o3 S <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Ma e this a"W" Permit 0 OK to Route to Other Departments <br /> Bld I/ ddn/Rem Size 7769 SF 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size a(/�,,4 Zone <br /> l `1 <br /> Number of Stories 2— Overlay/Agreement <br /> Basement QNo ❑Yes, Fin/Unfin Nonresidential Use 6ci Ce_. Cto o-. <br /> Type of Construction V.B Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load 77 Total No. of Dwelling Units: Et <br /> Fire Sprinklers: EtJpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes Etlo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cred. . _ <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes J No ❑Everett School Dist ❑Mukilt School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EtNo Additional Notes: '1,30 �, <br /> clika t C:J�+ �e_ - 1,,ej <br /> VALUATION CALCULATION: Total$Z-67�0017 0 €-vv r on i y -2�c oc C. q / <br /> aiVratee u•ii .41"' S rn i i-- <br /> Approved By: L. :11 Date: 7-30-17 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved B �,,- Date: 6�/!J rzpi9 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create 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-NO FIRE FEE AND 0 Is located in this folder <br /> ❑ Minimal or No.Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE 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 N <br /> Approved B AIL - Date:e 7A0izeyc' Approved By: 5Y/("7 Date: $ <br /> / y� <br />