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Intake &Approval Sheet •FOR PERMIT STAFF ONLY) PERMIT# �22� CID <br /> BUILDING PLANNING ' • <br /> Intake OK by: ef7 Date: 21k cif b' 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 ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size yocc.,4-4-2' 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone <br /> L..2. <br /> Number of Stories 'L _ Overlay/Agreement cC <br /> Basement ®No ❑Yes, Fin/Unfin Nonresidential Use . `\ -�T thA�,�PAI <br /> Type of Construction V gj Residential Use <br /> Occupancy Group & i. i S -t. Proposed No.of Dwelling Units: ...„ <br /> Occupancy Load `4' • Total No.of Dwelling Units: <br /> Fire Sprinklers: 111Update Existing ❑New System El Not Req'd PlanninglLandscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ _ <br /> Fire Alarm: IelUpdate Existing El New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credi • <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No ❑Everett School Dist ❑Mu.. -o School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ S50/coa <br /> Approved By j.--------- Date: 'Z ,tip_1'- t_ <br /> PUBLIC WORKS` <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> iDSys Dev Eval ❑TrafficMit Eval <br /> ❑Site Work or Drainage Proposed <br /> /L.) y ;OBackflow Prevention for high hazard: <br /> Approved By: ec T:. Date: 4 <br /> / / [(dental,medical,animals,mortuary,hospital, <br /> 111 6 €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 Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ), LaThis Permit is Approved by Public Works <br /> 0 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 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:\ r 2.)l?- (,(/f Date: 41 --- ---elk, 64 Public Works has no scope---PW Not Required <br /> -/, Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: 0 <br /> Approved By: Date: , Approved By4A4011 Au444 tf34{ti.) Date: I22)J24,2,2_. <br /> 2k <br />