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9 <br />Intake & Approval Sheet (FOR PERMIT STAFF ON09 <br />PERMIT # Q�,t C,($ —0l9 <br />BUILDING` <br />Intake OK by: Date: Z <br />Intake Comments: <br />❑ Route to Commercial Building <br />Pi Route to Residential Building <br />❑ Make this a "W" Permit <br />BldgfT ddn Rem Size <br />62-1- ,5fm, <br />aragg ccessory Struct. Size <br />b r <br />Number of Stories <br />Basement <br />[ffNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El New System ❑Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System El Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes <br />Add'I RCW 64.55 docs required prior to final? es ®No <br />VALUATION CALCULATION: Total $ Z% 006 <br />�i2'L � I21 7S',ZGZ <br />Additional Notes: 2c��.5 Ac �/jfs'Ee <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />-PLANNING <br />Intake OK by: Date: <br />Intake Comments: Assign To: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Z <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />d-. <br />Planning/Landscape Inspection Required before Final? ❑Yes o <br />"in Lieu" Fee: Type: Amount <br />School Impact Fee: Total $ <br />C dit: <br />Calculated: 11 <br />[]Everett School Dist ❑ Ilteo School Dist <br />A itional Notes: <br />Approved By: Date: q 77s )°) <br />1=1 <br />PUBLIC WORKS <br />Intake OK by: �� Date: 2.5 20 I �% <br />----------------------------------------- <br />Intake Comments: ;PW Worksheet Needed if.• <br />��,,// � S'ro t7 <br />61AI ,Ay,C- p-pp , ; , a ; t9Sys Dev Eval ❑Traffic Mit Eval <br />: FSite Work or Drainage Proposed <br />f 7Z 3Pf�t�w /2E?u►eEo: <br />013ackflow Prevention for high hazard: <br />�VD S'h-�1S1 �t oG�S (dental, medical, animals, mortuary, hospital, <br />'7- �oW.aS'PouT3, :supportive housing) <br />'----------------------------------------- <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 />❑ 1s in a Separate Green Folder Qoin 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 By: —WA <br />Date: <br />0 �' <br />