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Intake &Approval Sheet (FOR PERMIT STAFF ONL19 PERMIT# 2 (0 5— O// <br /> BUILDING PLANNING <br /> Intake OK by: - Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> ddn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/ ccessory Struct.Size Cj`1Q C" Zone IL' <br /> ur er of Stories / Overlay/Agreement <br /> Basement DINo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use kCx[},.A t) <br /> Occupancy Group- Proposed No.of Dwelling Units: <br /> Occupancy Load 7 i - Total No.of Dwelling Units: \ <br /> Fire Sprinklers: El Update Existing ❑New System pNot Req'd Planning/Landscape Inspection Required before Final? ❑YeV❑No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing ❑New System ONot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cr : <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes id No ❑Everett School Dist ❑Mu " eo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 'No Additional Notes: ,n0 c )k Q -r- '1-( . <br /> VALUATION CALCULATION: Total $ __ 30, 7� "vimO"" <br /> L(U <br /> L O Approved By: \L, Date: -h-2i <br /> 7�fJ BLIC WORKS <br /> J) 7020 Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> 3❑Sys Dev Eval ❑Traffic Mit Eval <br /> J� /.7-/A <br /> ❑Site Work or Drainage Proposed <br /> )Approved By: L � Date: =❑Backflow Prevention for high hazard. <br /> '(dental,medical,animals,mortuary,hospital, <br /> 'supportive housing) <br /> FIRE DEPARTMENT DRoute 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 El Fire Alarm ❑Other: ANl ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> iAee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: Sepa to PW Permit is Required (Permit#: PW 2(07-0 7) ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Lr!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 /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ 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: TT 6 Date: 7 3c zdLI <br />