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• <br /> • <br /> Intake &Approval Sheet (FOR PERMIT �2'Z"-1-01 pp ( STAFF ONLY) PERMIT# <br /> BUILDING PLANNING <br /> • <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 ❑ 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 NI1)j <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group //T 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: Am. nt$ <br /> Fire Alarm: El Update Existing❑New System ❑Not Req'd School Impact Fee: Total $ •- <br /> Reason Fire Alarm Required: Calculated: •s it: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist MI, ukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Addi".•- .. es: <br /> VALUATION CALCULATION: Total$ /Jb ADb,al, <br /> 1 <br /> Approved Date: j `\. LOU <br /> PUBLIC WORKS <br /> Intake OK by: . Date: i <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> _OSys Dev Eval DTraffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By f Date:&/�6/�2 Z a mortuary,/ _0Backflow Prevention for high hazard: <br /> (dental,medical,animals,m ary,hospital, <br /> !supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet -� <br /> Separate I Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND OCreate 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: • ❑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 81dg) <br /> Approved By: Date: aPublic Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: }e 513(2-022 <br /> Approved By: Date: Approved By: Date: <br />