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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# ZZ ?jQ(0 <br /> 110 I <br /> ^ BUILDING PLANNING <br /> Intake OK by: �( ,W6 Date: L( head Intake OK by: Assign To: • <br /> Date: <br /> Intake Comments: Intake Comments: <br /> G, aFtl/NC Corvve °& -- ea► d-e) <br /> • <br /> ❑ Route to Commercial Building 7r"Attach to Project No. <br /> El Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size S"00 S 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone K-1 <br /> Number of Stories Overlay/Agreement <br /> Basement IONo :Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use O ) <br /> Occupancy Group 1, Proposed No.of Dwelling Units: I <br /> Occupancy Load .141,(. Total No.of Dwelling Units: 00 <br /> Fire Sprinklers: ❑Update Existing ❑New System kINot Req'd Planning/Landscape Inspection Required before Final? ❑Yes gNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amo t$ <br /> Fire Alarm: ❑Update Existing ❑New System lNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: �bf Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? Ekes I1 No ❑Everett School Dist ❑Mukilte chool Dist <br /> Add'RCW 64.55 docs required prior to final? Ekes RNo Additional Notes: <br /> VALUATION CALCULATION: Total$ SO/000 <br /> Approved By: g.a Date: Co ,1f6.,7iZ <br /> 41 <br /> BLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: _PW Worksheet Needed if: <br /> 11-1 <br /> : Sys Dev Eval ❑Traffic Mit Eval <br /> `DSite Work or Drainage Proposed <br /> Approved By:'44, Date: W WW4, IDBackflow 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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: InThis Permit is Approved by Public Works <br /> Iltsee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: LJ A Separate PW Permit is Required(Permit#:PW 2/1-0 4 -0 3 2 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ais located in this folder <br /> ❑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 ❑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: i i�J�; Date: 5 (v&Jui i.' <br />