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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 162-t 0 5 - 0(:)g <br /> BUILDING � PLANNING <br /> { <br /> Intake OK by: Date: Intake OK by:G v-U Assign To: V--614tft-S• Date: S - IC) 2i 2. <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit 00K to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size — ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size F 'G 1-._ C Zone ly—L <br /> Number of Stories / Overlay/Agreement -i\J>✓'S,i(k 1-it civil c cJJcllGi� <br /> Basement ®No Oyes , Fin/Unfin Nonresidential Use <br /> Type of Construction 1IC Residential Use SF <br /> r <br /> Occupancy Group ,..,L//cf Proposed No.of Dwelling Units: <br /> Occupancy Load L_L/^` Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System [Zt of Req'd Planning/Landscape Inspection Required before Final? ❑Yes N3No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New Systemot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: it: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total$ d✓ 6 i <br /> --' 4‘4 Approved By:(y\1 L,e Date: 62 / Z( ``Z\ <br /> J,��, PUBLIC WORKS <br /> 15 <br /> Intake OK by: }e Date: Z0?,1 <br /> Intake Comments: <br /> Additional Notes: �c/�{, [PW Worksheet Needed if: <br /> eMirata J Y+ 3 <br /> ! Sys Dev Eval ❑Traffic Mit Eval <br /> `& itEtSite Work or Drainage Proposed <br /> Approved By: /_ � Date 47 f/ Q r�} ?OBackflow Prevention for high hazard: <br /> foil C.AO (vy :(dental,medical,animals,mortuary,hospital, <br /> Esupportive housing) <br /> Si.) sys (kV/ 'Cw�,s. ;.,.........,......._..._W..,...,...,._.....,..._.....,....,_._..,....,................._....,............ <br /> FIRE DEPARTMENT gstRoute 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 ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously El Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> ( See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: Ni.A Separateep� PW Permit is Required (Permit#: PW 2-10'-0 T L ) <br /> El Review of As-Built Plans-NO FIRE FEE AND Iris located in this folder <br /> El 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By`: i ~� ' Date: 4;2'IY (24 3 L.,' <br />