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Intake &Approval Sheet (FOR PERMIT STAFF ONL19 PERMIT# 31Z12-tboLk <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone 14 tj 0 <br /> Number of Stories Overlay/Agreement ROO <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use 1-11.rdrk-- <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ' No <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ ., <br /> Fire Alarm: ❑Update Existing [New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Cre ' . <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Everett School Dist ❑Mu . eo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: _ .` (04.(- ;, . -1 <br /> VALUATION CALCULATION: Total$ � etv ` 0.�Gli�lw�" \ <br /> 0(465 5t-v -, arein+ d <br /> Approved By: 4,\\*ja, <br /> Date: k"2_,--i(- <br /> PUBLIC WORKS <br /> Intake OK by 1 P Date: 12 r lio 12-614> <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> S•4.� 41.*3 v-iA+-.- ❑Sys Dev Eval OTraffic Mit Eval <br /> *40 -Ps•-.1 s co PF ❑Site Work or Drainage Proposed <br /> Approved By: V Date: 1 4(7( (e7 ❑Backflow Prevention for high hazard: <br /> 1 I (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: ❑ 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 Not • OP / /2 be,/a_o,S <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />