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�v t2—o <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY)• • <br /> PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: V"^-, Assign To:,/L/.) Date: I/is7 ! <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit AOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size O Yl J CP 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone U\c) .LA <br /> Number of Stories Overlay/Agreement <br /> Basement EirAo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use S 1\ <br /> Occupancy Group �e-- Proposed No.of Dwelling Units: <br /> Occupancy Load V17,4 Total No. of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System Mot Req'd Planning/Landscape Inspection Required before Final? ❑Yes &KINo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ONew System dNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: dit: <br /> RCW 64.55 MF worksheet req'd for permit? oyes No El Everett School Dist ❑ kilteo School Dist <br /> Add',RCW 64.55 docs required prior to final? DYes CiNo Additional Notes: <br /> VALUATION CALCULATION: Total$ ` <br /> %D dcY cF per" LCJJJ <br /> � ct Approved B • Date: _ ,2©Zk_ <br /> PUBLIC WORKS <br /> Y/,22 C''/ (9°!-k 4p-1 /J-0 Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: GU-�' "/��'�f�1 ❑Backflow Prevention for high hazard: <br /> PPDate: ! ;(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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> 0 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 /> la Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/ Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:\,160)wr Date: - 16-at 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: y . , Date: <br />