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2- <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) � PERMIT# -C-\91() � l (� <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Pip Assign To:111W_ Date: I/15/24 <br /> Intake Comments: Intake Comments: <br /> S; iA,Cry-. <br /> oNt. <br /> CI Route to Commercial BuildingIS htcotto. irr 6viAni <br /> ❑ Attach to oject No. <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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone M� <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 ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes Pipo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: ount$ <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cre t: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilte School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ f00 00 <br /> Approved By:/�,(�y/--� Date: j I i 57 7/` <br /> L PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: JPW Worksheet Needed if: <br /> I OSys Dev Eval OTraffic Mit Eval <br /> LISite Work or Drainage Proposed <br /> Approved B Date:p Z6 � i OBackflow 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 ❑Fire Alarm ❑Other: AND El Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑This Permit is Approved.by Public Works <br /> ❑ 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(join 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: g.Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: U 22.:1.1 <br />