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Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# S(�O( —OOS <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 /> Bidg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone �A <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> M-04\ — (kea,As e)rg5 <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 ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 'No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$�J <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: it: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0 No Additional Notes: ei)6,S r\ qn . tS <br /> VALUATION CALCULATION: Total$ r Wi_ k—J Oany � ko {efU n <br /> Approved By: IL, Date: 1 — t —11 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet N ededif• <br /> ❑Sys Dev Ev ❑Traffic Mit Eval <br /> ❑Site Wor or Drainage Proposed <br /> „ �j Date: p/ 444/ ❑Backf.w Prevention for high hazard: <br /> Approved By: `11 (dental edical,animals,mortuary,hospital, <br /> supp'- ive housing) <br /> FIRE DEPARTMENT El Route this folder for PW Review a -nd PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separat: concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder VA Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved 'y Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Wor heet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ONew System 0 Not Req'd 0 A Separate PW Pe'' it is Required (Permit#: PW <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND 0 Is locate. in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is in a .eparate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ❑ Will •e issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public orks has no scope---PW Not Required <br /> Addition. otes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />