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6 <br /> Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 4110 PERMIT# -'1)I O O1j <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ 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 /> Bldg/TI/Addn/Rem Size &15R 4+2- ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 950 Zone 0L <br /> Number of Stories Q_. Overlay/Agreement <br /> Basement giNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction `/-'F' Residential Use 6V,91,X C2. u(?r 6, <br /> Occupancy Group R 7 Proposed No.of Dwelling Units: A. l 1 <br /> Occupancy Load Total No.of Dwelling Units: ti <br /> Fire Sprinklers: ❑Update Existing ❑New System ®Not Req d Planning/Landscape Inspection Required bef <br /> ore Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑ rtxNew System I�INot Req'd School Impact Fee: Total $ \-] (6453 / <br /> Reason Fire Alarm Required: rah Calculated:-ix I6 VI Credit: dq 2y ✓ <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Everett School Dist lukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes igI No Additional Notes: V!214 t hao1 I r,veadr . <br /> VALUATION CALCULATION: Total S /9°3 rqjre6 far "Z.DZi vet6GHp,SJ1Q_. <br /> 0.4W -.t_ \ 9, c) (v2I) _ `�3B 3+ Approved By: K, .viciDate: a u <br /> zy ,2_1) PUBLIC WORKS <br /> (415- 26S) ( ) = 4l, Lsa <br /> - C� } - �$v Intake OK by: Date: <br /> � 3�- (30 PW WorksheetNeeded ,,,,,,,,,,,,,,, <br /> I �--�--- Intake Comments: Needed if: <br /> iiiOSys Dev Eval ❑Traffic Mit Eval <br /> i <br /> I DSite Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: 07 Date: git-8�2o2i <br /> / l =.(dental,medical,animals,mortuary,hospital, <br /> (supportive housing) <br /> FIRE DEPARTMENT DRoute 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 /> El Fire Sprinklers El Fire Alarm ❑Other: AN,► ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: .' W_; his 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 2 40 - O -4) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> 0-Minimal or No Fire Scope-NO FIRE FEE D, Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Sc e-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: (,� /„..— / <br /> Date: //KZ/2 ❑ Public Works has no scope PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: IK Date: 3 2 3 11,p <br />