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4110 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# e pZ_ C�h2�L.� <br /> BUILDING; PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <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 0 OK to Route to Other Departments <br /> BI /TI/ ddn/Rem Size / 21 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone 1`- <br /> Number of Stories n % Overlay/Agreement <br /> Basement ❑No EYes, in/Unfi Nonresidential Use <br /> Type of Construction �-_ Residential Use <br /> Occupancy Group `!/e-r° Proposed No. of Dwelling Units: <br /> Occupancy Load ///4 Total No. of Dwelling Units: e,4V, ('> <br /> Fire Sprinklers: ❑Update Existing ONew System "Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes czNo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount <br /> Fire Alarm: ❑Update Existing El New System'Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: � Calculated: C dit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑ tZ Yes No ❑Everett School Dist ❑Mu teo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes \IONo Additional Notes: <br /> VALUATION CALCULATION: Total $ /J .2(9 a <br /> /C.) <br /> Approved B � Date: 1S Zt, •te}'LA <br /> X Fo—91-/.( <br /> _ PUBLIC WORKS <br /> /5 ? L'i Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> C'/-44x6i-!y� �! P41�G7 i❑Sys Dev Eval ❑Traffic Mit Eval <br /> �� ��!!lJ 7/i <br /> orDraA r �/ l❑Backflow Prevention for high hazard: <br /> Approved By: �s Date: <br /> ;(dental,medical,animals,mortuary,hospital, <br /> (supportive housing) <br /> FIRE DEPARTMENT ❑Route 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 /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ 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 /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />