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• <br /> •Intake &Approval Sheet (FOR PERMIT STAFF ONLr PERMIT# ?Ati/A)��.. <br /> BUILDING PLANNING <br /> Intake OK b Date: r , it <br /> y: /a.�' c' Intake OK by: Assign To: ��� ` Date:.��-��a <br /> Intake Comment . (( Intake Comments: a Me- _ <br /> Et-Route to Commercial Building IX1 Attach to Project No. IJCA,,Q _ OAL-i <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 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 4$'4- 4+2- Zone .. f--—S <br /> Number of Stories Overlay/Agreement —' <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Vtj Residential Use 5t"14- <br /> Occupancy Group F. Proposed No.of Dwelling Units: <br /> Occupancy Load — Total No.of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing [hew System IgNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ®Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: C • : <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes It No ❑Everett School Dist ukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? Ekes tallo Additional Notes:f <br /> VALUATION CALCULATION: Total$ 14 i (o OD <br /> `tLi a 2 s Approved Be----- Date i' 1ZFal„ZOas <br /> PUBLIC WORKS <br /> Intake OK by: T)4 Date: f 2/23 r26/9 <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if. <br /> _I C 'R- -41K4►1"c DSys Dev Eval OTraffic Mit Eval <br /> CS V E4' 1.1 s-t-I N yr Q441-/ub <br /> OSite Work or Drainage Proposed <br /> Approved By: ` / Date: �1� � - o ?v.1 Sco4C- iDBackflow Prevention for high hazard: <br /> ;(dental,medical,animals,mortuary,hospital, ........... <br /> isupportive 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: ❑ 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 0 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: a -ublic Works has no scope---P Not Required <br /> Additional Notes: it2/23 l26 I'4 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />