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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT;620014 —IC) <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Build ng 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make pis-a""W°-Permit 0 OK to Route to Other Departments <br /> Bldg/TI(Addn/ em Size 6'p0 /5'F 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 4✓/4 Zone <br /> Number of Stories ( Overlay/Agreement ( i- 122.Z <br /> Basement .1allo ❑Yes , Fin/Unfin Nonresidential Use 1 •4 .. % 'jic'N- ..S <br /> Type of Construction VJr• Residential Use <br /> Occupancy Group Z. Proposed No. of Dwelling Units: <br /> Occupancy Load 3 Total No, of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System pNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes EiNo <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: punt$ <br /> Fire Alarm: Update Existing ONew System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? El Yes D No ❑Everett School Dist ukilteo School Dist <br /> I- <br /> Add'I ROW 64.55 docs required prior to final? El Yes 0 No Additional Notes: <br /> VALUATION CALCULATION: Total $ g� G <br /> 1 4- <br /> <(;(2)< /3'1/is'i::-. PY" <br /> Approved By: 7,A 41i Date: ' , 7, toles <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: iPW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> i❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved B7/- Date:/6 /� ' :(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 /> lElf-+re Sprinklers ,, ire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This 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 0 Is located in this folder <br /> 0 Minimal or No Fire Scope-NC) FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> rt-Zeview/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: yo y\ Date: /—,Z,� ,2O 0 Public Works has no scope--- PW Not Required <br /> Kr.vn(m .79—,24,20 Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: 5•�k . Date: 0 LI 1-o - <br />