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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ‘91)1 - D2(0 <br /> B ILDING 22 PLANNING <br /> L.3 <br /> Y <br /> Intake OK by: Date: k.- --k9 11--WIntake OK by: -�' Date: k 23—/q <br /> Intake Comments: t <br /> et) <br /> U , Intake Comments: Assign To: K... C' <br /> lc �-24 j V.e.nL ,Pcw J <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> O Make this a"W" Permit p OK to Route to Other Departments K N- Z-4,-i 9 <br /> Bldg/TI/Addn/Rem Size 3 0 2-41 4+1 z Hold in Planning.File Drawer <br /> Garage/AccessoriStruct.Size Zone j- I.M V b <br /> Number of Stories Z Overlay/Agreement \"-AvC <br /> Basement ONo ❑Yes, Fin/Unfin Nonresidential Use 441 (La 6\irA <br /> Type of Construction A Residential Use <br /> Occupancy Group M Proposed No. of Dwelling Units: <br /> Occupancy Load 4-ct Total No.of Dwelling Units: <br /> Fire Sprinklers:OUpdate Existing ❑New System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Reason Sprinkle s 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: Cre ' . <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes IX No ❑Everett School Dist ❑M eo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total $ 32- t:,E) <br /> Approved By: V__. Date: -Z 7- )1 <br /> L <br /> PUBLIC WORKS <br /> Intake OK by: V1- Date: 1 /2320 19 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> Nom► <br /> '–I`t C9 O.t....,-/ ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 0 o Sy s '>,✓v F+. 5 ❑Site Work or Drainage Proposed <br /> Approved By: j�% Date: ,21,2✓/(� 0'0o v_�' " —\f4o(z OBackflow Prevention for high hazard: <br /> I (\I® Pv-f sez)vt' (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE 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: 1;it'Update Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: Pepdate Existing ❑New System 0 Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: T 1Gn 'cZoeA i eW ��e., 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: WY1 Date: p2.—12-I 9 Public Works has no scope---PW Not quired <br /> Additional Note• / .3 /Zol9 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> (--„--) <br /> , <br /> h. <br />