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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT `9c `fl —056 <br /> BUILDING PLANNING <br /> Intake OK by: `; � Date: 4'Il <br /> a.2l/' Intake OK by: '1'1 Date: 4-2,7-----lei <br /> Intake Comme s: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> BldglTl/Addn/Rem Size /oZ, Z6-8 ,5F 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size /WA Zone tA—Z <br /> Number of Stories / Overlay/Agreement <br /> Basement WNo ❑Yes, Fin/Unfin Nonresidential Use (i e1Ao <br /> Type of Construction d�- <br /> �. <br /> { a Residential Use <br /> Occupancy Group .r-/i 8�'�— Proposed No. of Dwelling Units: <br /> Occupancy Load ,I/ Total No. of Dwelling Units: <br /> f <br /> Fire Sprinklers: ❑Update Existing JNew System :Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 74No <br /> Reason Sprinklers Required: - "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cr it: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 1 No ❑Everett School Dist ❑M teo School Dist Add'I RCW 64.55 docs required prior to final? ❑Yes EINo Additional Notes: 1ar VilSlte'�'ion.,, r.eJipsi -k — <br /> VALUATION CALCULATION: Total$ 54 %vo0.00 cbark- Ff `"u <br /> Aae60—0-"%' ' <br /> Approved By: �- �, Date: �_Z,Z�cj <br /> r, <br /> PUBLIC WORKS <br /> Intake OK by:--n.1 Date: 4/2 2 I 9 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> t•av *10 <br /> 6 K- Foo_ ,y-rqg_e ❑Sys Dev Eval ❑Traffic Mit Eval <br /> C-W '4„q"5 --6>:,J4 IBite Work or Drainage Proposed <br /> Approved By� Dater/Z/? c�� S€ �..� ott_".•-r ❑Backflow Prevention for high hazard: <br /> /�� (dental,medical,animals,mortuary,hospital, <br /> ?4 -al„46. 5'r'42-4 P,&a G supportive housing) <br /> FIRE DEPARTMENT llgRoute 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 ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 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 /> 1'21-Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: c..J n Dater=/4/ /'--- 1 Public Works has no scope---PW Not Required <br /> .0 r, ,/ _. ? Additional Notes: p %: a rrA <br /> ELECTRICAL mkt_ r �2%I/J't� /���, <br /> Additional Notes: f t /4 fed stepE • <br /> Approved By: Date: Approved By: Date: .bf <br /> Z4/9 <br /> @ <br />