Laserfiche WebLink
410 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 92bo' 'g OZ' <br /> BUILDING ' PLANNING yrp�/Q <br /> Intake OK by: Date: Intake OK by: Assign To: "�'i"V Date: <br /> Intake Comments: Intake Comments: <br /> El Route to Commercial Building -` 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> • f a e this a"W"Permit ,'OK to Route to Other Departments <br /> BI• U'•dn/Rem Size / 7Z� J�F ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 4/7/4 Zone VII —►1\ <br /> Number of Stories Overlay/Agreement <br /> Basement ki , o ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction /8 Residential Use <br /> Occupancy Group / Proposed No.of Dwelling Units: <br /> Occupancy Load y Total No.of Dwelling Units: <br /> Fire Sprinklers: aJpdate Existing ❑New System ❑Not Req'd P anning/Landscape Inspection Required before Final? ❑Yeslo <br /> Reason Sprinklers Required: "I Lie ee:Type: Amount$ <br /> Fire Alarm: 19 Update Existing El New System ❑Not Req'd S ho I Im act Fe : otal $ <br /> Reason Fire Alarm Required: Ca c lated: Cr it: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes a No ❑Everett Sc ool Dist ukilteo cho Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑ 1 <br /> Yes �S.J No Additional Notes: No 0,A-t r Jof Wof + reAJ t-e, cki. <br /> VALUATION CALCULATION: Total$ J7� ,00 a Pe oi S rCA4:f, <br /> Approved By(AA , Date: 1 i)i J� <br /> PUBLIC WORKS / / <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if. <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: �.,,�� Date: y <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 /> EfFife Sprinklers El Fire Alarm ❑Other: AND El Create Green Folder OSubmitted Previously El 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 /> a Review/Inspection Scope-ADD FIRE FEE g� El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K jw,n Date: 452�2# I�Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: M.‘ Date: i1 J 101s 0 <br />