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110 <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT# CgO3-010(4 <br /> BUILDING PLANNING <br /> _ Intake OK by: ' Date: 4 M Intake OK by: grti Date: — —) <br /> Intake Comme 4 Intake Comments: Assign To: <br /> c V6( ; ri 0-5—67)-1 44o r,: -.) <br /> fe).1\ n jj <br /> El Route to Commercial Building 01 Attach to Project No. 'II'A fb-CCU <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ►: •K to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size (9,673 lb a Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size ,----' Zone` `IJ"-2-gj <br /> Number of Stories / St Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use Pia40,4.riect--- <br /> Type of Construction V Residential Use <br /> Occupancy Group A _Z Proposed No. of Dwelling Units: <br /> Occupancy Load /3t Total No.of Dwelling Units: <br /> Fire Sprinklers: Jpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? 'IgiYes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ — <br /> Fire Alarm: Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: - -dit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ,ICI No ❑Everett School Dist ■ f ukilteo School Dist <br /> ❑ ' <br /> Add'I RCW 64.55 docs required prior to final? Yes 1^JNo Additional Notes: LOLf , yr- I ' . feri1 e-- <br /> VALUATION CALCULATION: Total$ IQ® OPQ ' GO or CO .• ?Al�Y - rot r 'rF0 <br /> Approved By: lt.,A Date: .ivi <br /> C <br /> PUBLIC WORKS <br /> Intake OK by: "7I4 Date: 3/4 f 14 <br /> Additional Notes: Intake Comments: PW Worksh et ttoded if:: <br /> New9.vrty-to a- ?► IgSys Dev Eval ❑Traffic Mit Eval <br /> Cu.o o�Frv-1-4 3'7Act-`'o DSite Work or Drainage Proposed <br /> 'a a� - �'�"'''c ❑Backflow Prevention for high hazard: <br /> Approved By: C Date: y.RQ, ii <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT IE,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 /> Elf-ire Sprinklers gEire Alarm ❑Other: Hood AND ❑Create Green Folder ❑Submitted Previously ODeferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items N 1 f} <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-NQ FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 14-Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:K p,co W,(l Date: e-f /C) ❑ Public Works has no scope---P Not Required <br /> Additional Notes: Jo cicijillamit or ?vs men?) <br /> - ELECTRICAL ` <br /> Additional Notes: vv . <br /> Approved By: Date: Approved By: Date: 518i'MCI <br /> 4- <br />