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Intake & Approval Sheet 10(FOR PERMIT STAFF ONLr 16. PERMIT # 0,I $12 -0b 1 <br />BUILDING <br />Intake OK by: Date: 12 S 5 <br />Intake Comments: <br />❑ Route to Commercial Building <br />Route to Residential Building <br />ake this a "W" Permit <br />Bldg/TI/Add em ize <br />S( <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />❑No LIYes , in Unfin <br />Type of Construction <br />Occupancy Group <br />01, <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes No <br />Add'[ RCW 64.55 docs required prior to final? ❑Yes ZNo <br />VALUATION CALCULATION: Total $ O�� %2_ <br />comer ens® "s" 5� zoo c�h� <br />�& 9 f -70 /Soe- Sz f di Zo ( 00MV <br />Additional Notes: /"-,c to <br />Approved By: Date: ZZ i <br />FIRE DEPARTMENT <br />Intake: (Needed for Townhomes, Alley load SFR, New Commercial) <br />❑Route to Fire Drawer--- Fire Preliminary Review Notice <br />❑Sending Fire Notes to Project Team <br />Date: (OK to Route to Other Departments) <br />Fire Sprinklers: ❑Update Existing ❑New System r�Not Req'd <br />Fire Alarm: ❑Update Existing ❑New System 93 Not Req'd <br />Chemical Sup: ❑Update Existing El New System Not Req'd <br />Additional Notes: <br />Approved f s Date: j-SL - f <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date: <br />Intake Comments: Assign To: <br />`Jii,e- (�k p� G Are, <br />, CdWe�i+� cF <br />r`2.- � o,- i` �v YQ�A ¢..J s N �, <br />Attach to Project No. Lw <br />❑ Route to Historic Reviewer <br />EKDK to Route to Other Departments )Z- <br />Hold in Planning File Drawer <br />Zone <br />R -} <br />Overlay/Agreement <br />Nonresidential Use <br />Residential UseL <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ Z. <br />Calculated: 'J-L Credit: <br />❑Everett School Dist ukilteo School Dist <br />Additional Notes: Ao,� n _ V�0 7ceo,12 <br />A0U CcvewAor - /fir-tt wigI2tl0sLfiS- <br />pproved By: vIIAMDate: <br />PUBLIC WORKS <br />Intake OK by: 7-,*J Date: <br />----------------------------------------- <br />Intake Comments: ; PW Worksheet Needed if.• <br />V> %SC-%) S Sr-o <br />ova4Q5re.� ; ❑Sys Dev Eva[ OTraffic Mit Eva] <br />-o ApJ <br />❑Site Work or Drainage Proposed <br />#40 3 ❑Backf]ow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />oute this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folder for permit issuance) <br />❑ Will be issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved Z Zq(1 <br />