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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) PERMIT# bi°\?*"...-°% <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:Csi Assign To: ( , Date: `.\t , ZA - <br /> Intake Comments: Intake Comments: <br /> .(3vV k�s9.a r A- <br /> ❑ Route to Commercial Building ❑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 /> Bldg/TI/Addn/Rem Size .6 "CAS- - ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size - Zone I v\u <br /> Number of Stories i- Overlay/Agreement <br /> Basement ®No ❑Yes, Fin/Unfin Nonresidential Use \� Z cc€0`. bk <br /> Type of Construction T(I- f:' Residential Use <br /> Occupancy Group A_- ft-2 € Proposed No.of Dwelling Units: <br /> Occupancy Load [04-0 Total No.of Dwelling Units: �—--- n� <br /> Fire Sprinklers: Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IlNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount '. <br /> Fire Alarm: ®Update Existing ❑New System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: -dit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No ❑Everett School Dist ❑ ,d ilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes M No Additional Notes: <br /> VALUATION CALCULATION: Total$ I) 5r)©Ai7 <br /> Approved B --��� _ Date: �-ZA�\ <br /> s <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> i❑Sys Dev Eval ❑Traffic Mit Eval <br /> t <br /> I❑Site Work or Drainage Proposed <br /> I <br /> Approved By: ) Date: 07 ym,2Q 0Backflow Prevention for high hazard: <br /> V� I(dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separateep� /Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Wire Sprinklers gEire Alarm .®Other: 400,5e AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> ❑ 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 /> iiit Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ^• sii,,n Date: / J/ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: A Date: C‘/q(Z,4 <br />