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1 Or <br /> Intake &Approval Sheet . (FOR PERMIT STAFF ONLY) 0 PERMIT# e 1- 60 <br /> BUILDING . . . PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> • <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 /> Bld I/ ddn/Rem Size j /1G) pCI, El Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone i "0} <br /> Number of Stories I Overlay/Agreement <br /> Basement tijNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group 5 Proposed No. of Dwelling Units: , <br /> Occupancy Load 70 Total No.of Dwelling Units: <br /> Fire Sprinklers: liSlUpdate Existing ONew System Mot Req'd Planning/Landscape Inspection Requi d before Final? ❑Yes 124,10 <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: INUpdate Existing ❑New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes In No ❑Everett School Di t ■ ukilteo School Dist <br /> Add'l RCW 64.55 does required prior to final? ❑Yes Jo Additional Notes: 0 •rf c/-` ve.ee.. <br /> VALUATION CALCULATION: Total$ /°/42".v0 V <br /> Approved By: K-, — Id Date: 10,•Z1. L 1. _ <br /> BLIC WORKS <br /> Intake OK by:l �'t V ' Date: 1 t f MS) <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if, <br /> /b -1' OSys Dev Eval ['Traffic Mit Eval <br /> .fir:A) <br /> v IDSite Work or Drainage Proposed <br /> Approved .�✓% Date j/ ZL `� "rp�. OBackflow Prevention for high hazard: <br /> //�� 1(dental,medical,animals,mortuary,hospital, <br /> V ;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: We SCm This Permit is Approved by Public Works 5+-c ZI 07 o 7 4 <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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(loin 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 134 X is f Date:TrZt/reZZ_, ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By:A.,,, AsP rr— - <br /> Date: O c3/.27/2Z <br />