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Intake &Approval Sheet 4111 (FOR PERMIT STAFF ONLY) ' PERMIT#r Y ,2P02.- Q <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 ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone_, U .. <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use N)0t.C€.0 - ( r al ti"`` <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load — - - Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IgNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: punt$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑ kilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: ,� �ce- - <br /> � � <br /> VALUATION CALCULATION: Total$L/u/kilo 0. 00 W�� <br /> Approved By: y! . i Date: I-Z(-2-0 <br /> L <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> OSys Dev Eval OTraffic Mit Eval <br /> I OSite Work or Drainage Proposed <br /> Approved B Date:c/ri Lb to OBackflow Prevention for high hazard: <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 /> ❑ 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 /> 0 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: 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 /> 2/Z <br />