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Intake & Approval Sheet • (FOR PERMIT STAFF ONL19 • PERMIT# 2`1,- OttA <br /> filiNve-Ari0JOIWInG4T 1 2 r ge ag <br /> k <br /> Intake OK by: Date: Intake OK Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route 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 <br /> Number of Storl:s Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use "V\AAA,\,%—i- C ,VvW <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑Ne System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ONo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New 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? NlYes MI o ❑Everett School Dist ❑Muki o School Dist <br /> Add'I RCW 64.55 does required prior to final? Wes ❑N• Additional Notes: <br /> VALUATION CALCULATION: Total$ ?IVV. <br /> Approved B Date: \\„\f& <br /> vo7 9RKs <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: I PW Worksheet Needed if: <br /> I❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> Approved By: a C�MD Date:2/gut <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> ir � � ems,.h <br /> ,-;.� a��, .,5 [ DEP Tr1 lir:,,,,��r, :,,,N„ ❑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 OFire Alarm ❑Other: AND ❑Create Green Folder OSubmitted 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: ❑A Separate PW Permit is Required (Permit#: PW <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> M 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:(;E GAO Date: i/g'f j\ 'Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> 114111141001§fatiktt7I7111 <br /> Additional Notes: <br /> Approved By: Date: Approved By: A Date: it/ <br /> lZf;o <br />