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Intake&Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# VD Vg1 — 029- <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 rV l - 1 <br /> Number of Stories - Overlay/Agreement <br /> Basement ®No DYes, Fin/Unfin Nonresidential Use <br /> Type of Construction 1\ — $ Residential Use <br /> Occupancy Group F- 'L Proposed No. of Dwelling Units: <br /> Occupancy Load — Total No. of Dwelling Units: <br /> Fire Sprinklers: qUpdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? DYes ❑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: _vv�� Calculated: Credit: <br /> _ <br /> ROW 64.55 MF worksheet req'd for permit? DYes .rna No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I ROW 64.55 docs required prior to final? DYes oallo Additional Notes: <br /> VALUATION CALCULATION: Total$ 1S(49 don <br /> i <br /> /< <br /> Approved �.�/ Date: (// Z /'/X"` <br /> PUBLIC WORKS <br /> Intake OK by: 5 Date: l/ <br /> Additional Notes: Intake Comments: i PW Worksheet Needed if: <br /> :OSys Dev Eval ©Traffic Mit Eval <br /> �/ / 1 ©Site Work or Drainage Proposed <br /> I T`� !/!•u DBackflow Prevention for high hazard: <br /> Approved By: Date: lilt 5/ 0 <br /> 111 V(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 ❑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 ❑ Not Req'd AND 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing Clew System ❑ Not Req'd 0 Is in a Separate Green Folder (join with this folder for permit issuance) <br /> Additional Notes: El 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 Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />