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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ? 2V: OV, <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 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> BI�q[TT'ddn/Rem Size 2,50 ,51f ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Ail) Zone `S <br /> Number of Stories Z Overlay/Agreement <br /> Basement 10No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction 2 f C Residential Use S K <br /> Occupancy Group C/zC Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System riNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amo <br /> Fire Alarm: El Update Existing El New System 'Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: redit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No ❑Everett School Dist ❑ kilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes InNo Additional Notes: <br /> VALUATION CALCULATION: Total $ •-i-0 6, b "7 <br /> Approved B Date: \\,O\_ COL\ <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval I <br /> ❑Site Work or Drainage Proposed <br /> Approved By: z Date:l// r&-e i _❑Backflow Prevention for high hazard: <br /> :(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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create 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: 0 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 /> ❑ 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 Bldg) <br /> Approved By: Date: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />