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Intake &Approval Sheet *FOR PERMIT STAFF ONLY) • PERMIT# 13 Z 26 Z'b IS <br /> BUILDING _ PLANNING' • . •- . <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> e <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 2%j J qgcit ..4-..4-" ElHold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone WSNumber of Stories J... Overlay/Agreement _ <br /> Basement ZNo ❑Yes, Fin/Unfin Nonresidential Use . �?a€j t�n�rb4 - <br /> Type of Construction • V... Residential Use <br /> Occupancy Group F - 3. , S— i Proposed No.of Dwelling Units: <br /> Occupancy Load 3 l • • Total No.of Dwelling Units: / . <br /> Fire Sprinklers: ❑Update Existing ❑New System tiCINot Req'd Planning/Landscape Inspection Required befor final? ❑Yes (o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: aunt$ <br /> Fire Alarm: 17.1Update Existing El New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: edit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes N No ❑Everett School Dist ❑M ilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes MNo Additional Notes: /11 3 et.9j 146 ' / <br /> VALUATION CALCULATION: Total$ tW e! <br /> Approved By: )L. Date: it.2`, ZZ <br /> UBLIC WORKS' <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> =DSys Dev Eval ❑Traffic'Mit Eval <br /> • <br /> ❑Site Work or Drainage Proposed <br /> Approved By: t Date: .4( Ia3(yes7_ti ;1]Backflow Prevention for high hazard: <br /> 1 :(dental,medical,animals,mortuary,hospital, <br /> isupportive 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 , ire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> J • <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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> rffReview/Inspection Scope-ADD FIRE FEE �t ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:-, Cahn Date: 4/. ��2 I�1 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL no(' I .h01 � eA as wh1'Vvsoa( 41 IIib 7"0k1` <br /> f oC,t dtkr/ <br /> Additional Notes: <br /> Approved By: Date: Approved By:AmbitAQ/t/Im/v1't Date: 31 2112 2-.2. <br /> fv <br />