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Intake &Approval Sheet (FOR PERMIT STAFF ONLY PERMIT# Zk5LO --b2 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:_44____ Date: I-- 17_ )q <br /> Intake Comments: Intake Comments: Assign To: g_, <br /> 1404 1-0 avaek— 24na— i. Yf-w,-en/5 re-i✓1 M ub <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 Cti OK to Route to Other Departments kit—pi <br /> Bldg/TI/Addn/Rem Size 44-1 42_4 -fold in Planning File Drawer tCy- <br /> Garage/Accessory Struct.Size — Zone S-1.-FAU U <br /> Number of Stories 1L Overlay/Agreement NAJO <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction t[- 'le Residential Use <br /> Occupancy Group I' Z-1� '�7 Proposed No. of Dwelling Units: <br /> Occupancy Load 322-- Total No. of Dwelling Units: <br /> Fire Sprinklers: VlUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes piNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$_/ <br /> Fire Alarm: XUpdate Existing ID New System 13 Not Req'd School Impact Fee: Total $ 7 <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No E3 Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 'No Additional Notes: Avixojel a55cieZrAiNc� <br /> VALUATION CALCULATION: Total$ 4-00 OpD �T0S fegv�� / O <br /> Approved By: 44,,,.x.\ Date: -5_21_`q <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> 42I <br /> ❑Site Work or Drainage Proposed <br /> Approved By: ` Date: ❑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 /> 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 E3 Create Green Folder ❑Submitted Previously ODeferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) ❑ 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 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing 0 New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: IV d F&e, El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:u, Wh Date: I-,Z,,q-lqj IN-.ublic Works has no scop --- PW No equired <br /> Additional Notes..✓��� /3/2.6/q <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />