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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# blv l O' 'b1)1 <br /> y(�BUILDING © PLANNING <br /> Intake OK by: 4I Date: j//9//4% � <br /> Intake OK by: W Date: '27 -'146-)1 <br /> Intake Comments: Intake Comments: Assign To: v_.. ci <br /> Or- 4°0'4 (La ' 11e. Oaf) Cariec.l any <br /> {e40,lfet, - en.Wkil --cv cke0 Ccwn1- €✓ coal l-4(-- <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 171OK to Route to Other Departments <br /> Bldg/TI/Addn�fFe_TySize `,-'7 7 . 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size e-s-- Zone s --2— <br /> Number <br /> Number of Stories 1 Overlay/Agreement <br /> Basement ❑No Wes Fin Unfin Nonresidential Use <br /> Type of Construction Residential Use r )2. <br /> Occupancy Group Proposed No. of Dwelling Units: — <br /> Occupancy Load Total No. of Dwelling Units: I <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes I.puyo <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: Cred' . <br /> RCW 64.55 MF worksheet req'd for permit? Oyes IN No ❑Everett School Dist ❑Mukil School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes EJo Additional Notes:j,teor•04 UNAiD�S�o.� SF'R� -� � <br /> . 0 <br /> VALUATION CALCULATION: Total $ 1 71 5-Z3 0$' AO J <br /> OY ‘f 6-3' 7J Approved By: td.,„,.1Date: -J' 2i -19 <br /> e/3 S,/ CI/ <br /> PUBLIC WORKS <br /> Intake OK by: T ta Date: r <br /> " .3 ; s , ... .1 <br /> Additional Notes: 20/5- /, Intake Comments: PW Worksheet Needed if: <br /> svo ...o <br /> -,,,,,S,a,�to -$s►sew•E.+ic ❑Sys Dev Eval ❑Traffic Mit Eval <br /> "4-io114` <br /> DSite Work or Drainage Proposed <br /> Approved By: Date: 3/z6-7/9 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I 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: ❑ This Permit is Approved by Public Works <br /> i U)treopitneL0 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(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 /> i <br /> Approved By: Date: ❑Public Works has no scope--- PW Not Required <br /> Additional Notes: y <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> Z/2 <br />