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Intake & Approval Sheet • (FOR PERMIT STAFF ONL1) • PERMIT# D 2(k -OC <br /> BUILDING PLANNING 11 <br /> Intake OK by: Date: Intake OK by Assign To: Date: l\•tO <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commer 'al Building ❑ Attach to Project No. <br /> ❑ Route to Residential zuilding ❑ 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 Zone -?j`-_ <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use y\&"A'; vti a\ <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 ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System ■ of Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: t� Calculated: Creel' : <br /> RCW 64.55 MF worksheet req'd for permit? I�Yes ❑ o ❑Everett School Dist El Mu ' eo School Dist <br /> Add'I RCW 64.55 does required prior to final? 'Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ tu1< <br /> Approved By 1 — Date: A \a Ir tc.) <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❑Site Work or Drainage Proposed <br /> / rO�/� ❑Backflow Prevention for high hazard: <br /> Approved By: Date: ` (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 El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted 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 /> ❑ Review/Inspection Scope-ADD FIRE FEE <br /> ❑ 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 /> " L Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> 1 <br /> Approved By: Date: Approved By: J; Date: �' i2 ?9 <br />