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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />BUILDING <br />Intake OK by, Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />,23 <br />Garage/AccessoryGarage/Accessory Slruct. Size <br />Number of Stories <br />Basement <br />MNo ❑Yes Fin / Unfln <br />Type of Construction <br />V'1i> <br />Occupancy Group <br />OccupancyOccupan2y toad <br />I « <br />Fire S r)nklers; ❑Update Existing VNew System []Not Req'd <br />Reason Sprinklers Required: <br />Firo Alarm: ❑Update E3dsting New System ❑Not Re 'd <br />Reason Fire Alarm Required, <br />RCW 64.55 MF worksheet req'd for permit? OlYes ❑ No <br />Add') RCW 64.55 does required prior to final? QYes WNo <br />VALUATION CALCULATION: Total $ I �✓ 0 <br />i2 y, 544- ell t) <br />Additional Notes: <br />Approved By: Date: C► l'?a �Ci <br />FIRE DEPARTMENT <br />Separate I Deferred Submittals Required: <br />lure Sprinklers BbIre Alarm ❑Other:_..._._ <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />RReview, / Inspection Scope - ADD FIRE FEE <br />lApproved By: Date: Ito, — <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PERMIT # <br />PLANNING <br />Intake OK by: Assign To:Date,___ <br />Intake Comments: <br />❑ Attach to Project No; <br />❑ Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />R-4 <br />Overlay/Agreement <br />N/A <br />Nonresidential Use <br />Residential Use <br />YES <br />Pro osed No. of Dwelling Units, <br />Q 3 <br />Total No. of Dwelling Units: <br />1 11-2 <br />Planning/Landscape ins a fired before Final? Yes ❑No <br />"In Lieu" Fee: Type: <br />Amount $ <br />School Impact Fee: otal 13 846 <br />Calculated: 23 $ ,010 edit: 80%, $55,3134 <br />®Everett School st ilteo School Dist <br />Additional Notes: Final TyD�M,�required prior to C/O <br />�G,3Tf31J I -�Vf J'J <br />Approved By: Date: 10.9.zozo <br />la <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PIN Worksheet Needed If: <br />[]Sys Dev Eval []Traffic Mit Eva) <br />JSite Work or Drainage Proposed <br />08ackftow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />supportive housing) <br />❑ Route this folder for PW Review at end -- PWReview Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously Deferred <br />This Permit is Approved by Public Works <br />,See PW Review Worksheet and associated attached items <br />fA Separate PW Permit Is Required (Permit #: PW 6 ' `o <br />AND ❑ Is located In this folder <br />5�Is In a Separate Green Folder (oln with this folders permil issuance) <br />❑ W III be Issued separately (separate Green Folder, PW Issued ahead of Bldg) <br />❑ Public Works has no scope -- PW Not Required <br />Additional Notes: <br />Approved By: Date: -.. 2GL.� <br />'1,44 <br />