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Intake &Approval Sheet (FOR PERMIT STAFF ONO) PERMIT# j3:72-M; <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: VIntake Comments: <br /> El Route to Commercial Building ❑Attach to Project No. <br /> oute to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/ em Size 3 Z-0 S Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories 2 Overlay/Agreement <br /> Basement B,NO ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction C Residential Use <br /> Occupancy Group 54-( Proposed No.of Dwelling Units: <br /> Occupancy Load t Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes o <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: ount$ <br /> Fire Alarm: ❑Update Existing ❑New System MNot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: /oSichool <br /> t:RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukil Dist <br /> Add'I RC'W 64.55 docs required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total $ /� c) `�y <br /> Approved By: L_ Date: _ <br /> "-PUBLIC WORKS <br /> Intake OK by: Date:_ <br /> Additional Notes: Intake Comments: PW Worksheet Needed if. -~- - <br /> ❑Sys Dev Eva[ ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: _ Date: ]W 12Z Z2 ❑Backflow Prevention for high hazard: <br /> IZ-k ;(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> t <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: is 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 7­3 P 3 `G'O i) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND b4s located in this folder <br /> EJ�Ainimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folderfor permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: '�,r6(pL,,n Date: '�5 —�,23 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved B Date: A roved B -o - ---Dater 3 �z3 <br /> pp Y pP Y _ - <br />