Laserfiche WebLink
0 • / � � <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#�21ocv - Ol `( l <br /> BUILDING PLANNING <br /> Intake OK by:J Date: 7(12-/Ze(Z-1 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 /> Bld /TI/Addn/Rem Size z <br /> g �S� •�" 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories ,,,�- Overlay/Agreement <br /> Basement L'�No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use �)-60-.4) _ <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load ,--,/ Total No. of Dwelling Units: 1 <br /> Fire Sprinklers: ❑update Existing ❑New System LL(Not 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 L( i t Req'd School Impact Fee: Total $ ' <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo chool Dist <br /> Add'l RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: ' ')C pO e- <br /> VALUATION CALCULATION: Total$ f- 9,00 0 `�" t"I <br /> Approved By: ILA . Date: I U,S Li <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> I❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: (L- Date: 37.21/j-e2, TOBackflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> ❑Route this folder for PW Review atend...................................Review ,,.,.,..................,,. <br /> FIRE DEPARTMENTend ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers OFire 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: ❑ 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 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: / 7 2 Z <br />