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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# bOO9 --OCI <br /> BUILDING PLANNING �.�1 <br /> Intake OK byi ./4. Date:areS/Z0/i' Intake OK by: Date: CV 6 . I <br /> Intake Comments: Intake Co ments: Assign To: V—• d <br /> eteit^ ryt_ed <br /> -Venal* _ 4f A f fi'(eAl* Q ' CO <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 OK to Route to Other Departments <br /> Bid^0ddn/Rem Size `f''i, `%b Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ,(/l Zone 1" — Z <br /> Number of Stories 1 Overlay/Agreement <br /> Basement ®No ❑Yes , Fin/Unfin Nonresidential Use 0 t ,e/Aiy,'b, 1,1) _ <br /> Type of Construction �L /, Residential Use <br /> / <br /> Occupancy Group WC--/ Proposed No. of Dwelling Units: <br /> Occupancy Load /y9 Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing New System ONot Req'd Planning/Landscape Inspection Required before Final? EYes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: mount$ <br /> Fire Alarm: ❑Update Existing II��laiNew System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: edit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No ❑Everett School Dist ❑Mu .teo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes El No Additional Notes: < ,t lY.. �Pi C',r <br /> VALUATION CALCULATION: Total $ g/,a/7T.0,CQ Octke "c F <br /> Approved By: `.e A Date: 1 e' <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 /> ESite Work or Drainage Proposed <br /> Approved By: h /7,/a.am, Date: /� 9 ❑Backflow Prevention for high hazard: <br /> ��� (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 /> -.Eire Sprinklers -#r 'Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 2This Permit is Approved by Public Works <br /> ei&Review Worksheet and associated attached items <br /> Fire Dept. Fees: P,A Separate PW Permit is Required (Permit#: PW/91(—02-53- ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0,1 Is located in this folder <br /> 0 Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> a Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By , re w Yl Date: 12—/—/q El Public Works has no scope---PW Not Required N t' ( •-I,K Va Additional,Notes: �,Q ovii silica( <br /> r - /-� - ) <br /> ELECTRICAL T3t1 i'UJ !" 1. <br /> Additional Notes: 4,EJ1 �� 0�9Approved By: Date: Approved By: / Date: ,� pi ,— <br />