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Intake &Approval Shee (FOR PERMIT STAFF O`D PERMIT#tiN c$62 - ©32_, <br /> BUILDING PLANNING <br /> Intake OK by: � Date: 1 o !$ Intake OK by: )i-* Date: 12 0-1(6 <br /> 411 <br /> Intake Comments. Intake Comments: Assign To: <br /> d� "‘^1,0.142.- ca,„11/4- •*U <br /> 2�J1 <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> VveY�-,cJz— <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit .OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone ' I <br /> Number of Stories Overlay/Agreement <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 :hot Req'd Planning/Landscape Inspection Required before Final? ❑Yes gNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amo <br /> Fire Alarm: ❑Update Existing ❑New System E3 Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ED Everett School Dist ❑ kilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0 No Additional Notes: A �� c �tea'` <br /> VALUATION CALCULATION: Total$ GS�O00 a� f ) I <br /> arv!, <br /> 4b& do(5 <br /> Approved By: lL,�o-,,,.� Date: )1 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Works -et Needed if: <br /> ❑Sys I-v Eval ❑Traffic Mit-Eval' <br /> 051 -Work or Drainage Proposed <br /> Approved B '. Date:©yo//i.0/9 •:ackflow Prevention for high hazard: <br /> dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Re '-w at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a se.arate concurrent PW Review(Green Folder) <br /> El Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Fol.er El Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Appr. ed by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review orksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd 0 A Separate P Permit is Required (Permit#: PW <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND ❑ Is lo :ted in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is i a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ❑"iIll be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />