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0 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#r-62004.-0C)CA <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> O Route to Commercial Building 0 Attach to Project No. <br /> 0 Route to Residential Building El Route to Historic Reviewer <br /> O Make this a"W"Permit El OK to Route to Other Departments <br /> Bidg/TI/Addn/Rem Size ..4(c) 70 E ST 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size /j/4 Zone <br /> Number of Stories Z_ Overlay/Agreement <br /> Basement .. No DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction V-..4 Residential Use <br /> Occupancy Group .WL_ --7.—i C') Proposed No. of Dwelling Units: <br /> Occupancy Load /14 Total No. of Dwelling Units: <br /> Fire Sprinklers: N Update Existing EINew System EiNot Req'd Planning/Landscape Inspection Required before Final? 0Yes ) Jo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount <br /> Fire Alarm: 4 Update Existing 0 New System El Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cre ' . <br /> RCW 64.55 MF worksheet req'd for permit? Ores R No DEverett School Dist DMukilto School Dist <br /> Add'I RCW 64.55 docs required prior to final? ElYeS No Additional Notes: lo‘<t)ce— dirro uvrv-1— (NC° kiti.4"7-A-0, <br /> VALUATION CALCULATION: Total $ /l6/71/4 0 itme,lor n4-e--,444offaiel 44 A44-4'4 Approved By:By: \LAI- Date: e-4— <br /> UBLIC <br /> BLIC WORKS <br /> -Cr <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: <br /> IPW Worksheet Needed if: <br /> j <br /> 47.fiRreArirra irO/L T.r zS ,06-/iiPe..4 4. <br /> 10Sys Dev Eval OTraffic Mit Eval <br /> Approved ,de,..7-, Date:0-7/f 74,67,e, <br /> B,Ic .-‘. IOSite Work or Drainage Proposed <br /> i LJBackflow Prevention for high hazard: <br /> i <br /> i(dental,medical,animals,mortuary,hospital, <br /> iisupportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: OThis project also has a separate concurrent PW Review(Green Folder) <br /> ElFire Sprinklers OFire Alarm DOther: AND I:Create Green Folder 0Submitted Previously ElDeferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> El See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required(Permit#: PW ) <br /> El Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> El 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 El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K 1- -0.- <br /> „ , (-N Date:2-2;zaZo Gr-Public Works has no scope---PW Not Required <br /> Additional Notes -o—7 i a J <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2k------ <br />