Laserfiche WebLink
0 <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 2Dt)(0-0 n <br /> BUILDING PLANNING <br /> Intake OK by: Cirit Date: 6/2:2-/Zc7 Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> Et-Route to Residential Building ❑ 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/Accessory Struct. Size 5 40 sc. Zone 12.—1 <br /> Number of Stories I Overlay/Agreement <br /> Basement No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use talA _ el 5'iZ <br /> Occupancy Group u Proposed No.of Dwelling Units: -- <br /> Occupancy Load Total No.of Dwelling Units: 1,• <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amo t$ <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit- <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilte chbol Dist <br /> Addl RCW 64.55 docs required prior to final? ❑Yes ID No Additional Notes: A os, rbr sr - p\,,\5 <br /> VALUATION CALCULATION: Total$ �si"I2 2 <br /> Approved By: \\,,,\,. <br /> Date: 1,1�j,'Z ZO <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Z0/6" /4C Intake Comments: jPW Worksheet Needed if: <br /> , <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved B Date:07/ Zd ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> 'supportive housing) <br /> FIRE DEPARTMENT ❑Route 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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred <br /> -F <br /> Additional Notes: , This Permit is Approved by Public Works <br /> 0 See 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder coin with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ 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 /> Approved By: Date: Approved By: Date: /(beill.4 Zca <br />