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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) 0 PERMIT# 1?)`_l O (r-03-k <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> O Make this a"W"Permit 0 OK to Route to Other Departments <br /> BId /TI/ ddn/Rem Size 2 /76- 0 Hold in Planning File Drawer <br /> / <br /> Garage/Accessory Struct.Size fisi Zone 11--1— <br /> Number of S_tories Z- Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Ice Residential Use <br /> Occupancy Group 13 Proposed No.of Dwelling Units: <br /> Occupancy Load tf 39 Total No. of Dwelling Units: <br /> Fire Sprinklers: OlUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes giNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Am t$ <br /> Fire Alarm: ®Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cre : <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El No ❑Everett School Dist ❑Muki o School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional� Notes: lifl}'erjly— upp,('L ©A <br /> VALUATION CALCULATION: Total$ ,583260,E -e)(kt `o drarvs ce e,,D-pc, m,r .i • (Sm.,- <br /> -t'lx-io perm A--- ,n0 G aA L pee n <br /> Approved By: f-- Date: 2-1- <br /> _ Icy <br /> UBLIC WORKS <br /> Intake OK by: V 4- Date: 41/2- � jzo l 9 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> I tt.l' is.o vs— T $ o"L`f <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> '^I b J 5 Cots ❑Site Work or Drainage Proposed <br /> Approved B Date:Orz,j//�y7 =❑Backflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> N :supportive housing) <br /> _._ ..._.................................r_._.....,_.._....................._ .__................. <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate 'eferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprin' -rs ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope- 0 FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/I ection Scope-AID FIRE FEE El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By Date:0/s /j Q Public Works has no scope--- PW Not Required <br /> / Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> Zk <br />