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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# Cep A. 0 -oES <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ 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 ❑ Hold in Planning File Drawer <br /> Garage/ ce o Struct. ize WO Zone c-3 <br /> 7 <br /> Number of Storl 1 / Overlay/Agreement <br /> Basement NNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction V6 Residential Use 'IAL\�1 —-qvA i <br /> Occupancy Group "1-3 Proposed No. of Dwelling Units: Y <br /> Occupancy Load L7 Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System C Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes Callo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amountj' <br /> Fire Alarm: El Update Existing ❑New System Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: CCa� Calculated: --dit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes a No ❑Everett School Dist ❑i• kilteo School Dist <br /> Add',RCW 64.55 docs required prior to final? ❑Yes ,NNo Additional Notes: <br /> VALUATION CALCULATION: Total $ � COO <br /> Approved B Date: \ ,Z.0 yta <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 /> ❑Backflow Prevention for high hazard: <br /> Approved By: f , Date: iindizew (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: O This Permit is Approved by Public Works <br /> j1See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans- NO FIRE FEE AND ❑ Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> O 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 Notes: <br /> r <br /> Approved By: Date: Approved By: �l.it Date: .) �'0 2!j <br /> 7�7/ <br />