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2c01 Ulbii-002-- ® , <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT#(..\)0, b\t <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> ake 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 ErOK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 2,l t)2 [p 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 1421 Zone . , W C <br /> Number of Stories 2... Overlay/Agreement 1M 4'$ Pia IA-- <br /> Basement <br /> . -Basement 51/No ❑Yes, Fin/Unfin Nonresidential Use - - <br /> Type of Constructionillluu Residential Use GvV� <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: I <br /> .�.,,�� <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 'Rio <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing [hew System ❑Not Req'd School Impact Fee: Total $ A,LV- pat- ---. <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 0 No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> 00 <br /> rLUATION CALCULATION: Total$ 2-551'2. 1, -- <br /> U16 1 P.G 4 W 6C1 <br /> Approved Date: 11/0. //677 <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 /> ❑Site Work or Drainage Proposed <br /> Approved By: it/249 ❑Backflow Prevention for high hazard: <br /> CM'j ►► <br /> (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) OThis 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 IRThis Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) OSee PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing [hew System 0 Not Req'd ►' A Separate PW Permit is Required(Permit#: PW f q0q/os ) <br /> Fire Alarm: ❑Update Existing Chew 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 /> =proved By: Date: 0 Public Works has no scope---PW Not Required <br /> ' Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: s- Date: 11(/237/j jq 4 <br />