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• <br /> • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# M11:3 . <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: � <br /> U '-' Date: /0 POO <br /> Intake Comments: Intake Comments: <br /> i , <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute 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 nil— I <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Dyes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing El New System ❑Not Req'd Planning/La►..cape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu"Fe-:T .e: Aunt <br /> $ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Im'iact Fe-: Total <br /> Reason Fire Alarm Required: Calcul i►d: Cred' <br /> RCW 64.55 MF worksheet permit?for d re ' ❑Yes ❑ No q ❑Everett School Dis ❑Muki t: School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: Aides I,fprr_re, ed c+r' <br /> VALUATION CALCULATION: Total$ alp rare01 v - O z I+c <br /> Approved By: a Date:10 )3 <br /> / PUBLIC WORKS <br /> / I <br /> Intake OK by: Date: <br /> �.r-►� i A Intake Comments: <br /> Additional es: ®/ €PW Worksheet Needed if: <br /> �y 4c ��S Sys Dev Eval ❑Traffic Mit Eval <br /> „9fr V � 7 Site Work or Drainage Proposed <br /> Approved By: ❑Date: (0 651 , l DBackflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> \ 'supportive housing) <br /> , W _.._..._..................._...___...__.... ...................._......__.._. ............ <br /> FIRE DEPARTMENT ❑Route this folder for\"W Review at end ---,- eview Worksheet <br /> Separate I Deferred Submittals Required: ❑This project also has separate conc -'''PW Review(Green Folder) <br /> El Fire Sprinkles ❑Fire Alarm ❑Other: AND ❑Create Green Fol.-r ❑Su.,y Itted Previously ❑Deferred <br /> • <br /> Additional Notes ElThis Permit is Approved b \P.:lic Works 1- <br /> \ / 4 3 <br /> ❑ See PW Review Works/Jet. nd associated attached items <br /> Fire Dept. Fees: \ \' El Separate PW Per II is Req'd(Permit#: PW ) <br /> ❑ Review of As-Built ,-ns- A FIRE FEE AND ❑ Is locate./n this folder \`� <br /> ❑ Minimal or No Fire j NO FIRE FEE ❑ Is in aeparate Green Folder(ioin`••'tthh this folder for permit issuance) <br /> ❑ Review/Inspects.- Scopee"\ADD FIRE FEE ❑Will e issued separately(Separate Gree elder,PW issued ahead of Bldg) <br /> Approved By: / \ Date: ❑ Public /orks has no scope---PW Not Required <br /> \ Additional' otes: <br /> ELECTRICAL\ <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> .24., <br />