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• • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# PA (10 60 <br /> BUILDING PLANNING <br /> Intake OK by: \., 61 - Date: 4/26 /(4 Intake OK by: Assign To: -k\4.(/1 Date: v1.2LP•\"I <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 BE OK to Route to Other Departments <br /> Bldg/TI/4cffdar Rem Size ,3o0 S,F 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size ,ts% Zone '?— <br /> Number of Stories Overlay/Agreement — <br /> Basement GENo ❑Yes , Fin/Unfin Nonresidential Use — <br /> Type of Construction 7.0 Residential Use ‘ <br /> Occupancy Group 'R Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: C' <br /> Fire Sprinklers: ❑update Existing ❑New System ®Not Req'd Planning/Landscape Inspection Required before Final?ja es ❑No <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amour ., <br /> Fire Alarm: ❑Update Existing ❑New System Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: -Calculated:_ C dit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑ r�I Yes No ❑Everett School Dist ❑Mu 'teo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ElNo Additional Notes: <br /> VALUATION CALCULATION: Total$ 'A 30 0 <br /> Approved ------ Date: 1Z ,'LT <br /> PUBLIC WORKS <br /> Intake OK by:I R . Date: I /ZLc j Z 0 i 5 <br /> Additional Notes: 20 !5 /QL 4# /4 SEC Intake Comments: PW Worksheet Needed if: <br /> •S1--9-- 4 vDi-r`p"3 =1Sy D v Eval ❑Traffic Mit Eval <br /> ^-3 0 0 5'- <br /> ;Site Work or Drainage Proposed <br /> Approved By: — Date: 12J g i(cj -4-wv. me...,+..it?6%.1T i❑Backflow Prevention for high hazard: <br /> by= -re. %t D4. �i'�HiF(dental medical,animals,mortuary,hospital, <br /> IQ/l�/1� 'supportive housing) <br /> FIRE DEPARTMENT p Route this folder for PW Review-at.. ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: A#25;( / , . Date: / Z ' /? <br /> II <br /> Zi2 <br />