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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) 4111 PERMIT#1- l0 ft '" 04 (e <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg,7j ,ddn/Rem Size 2_6/60o ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size i(/ ,Q Zone pJ\ - <br /> Number of Stories Overlay/Agreement <br /> Basement .No ❑Yes, Fin/Unfin Nonresidential Use \ <br /> C' t\ `N\QNAV aCIAi k°) <br /> Type of Construction /7 T/ Residential Use <br /> Occupancy Group /3 j S- / Proposed No.of Dwelling Units: <br /> Occupancy Load g4 Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing rilNew System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes KINo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing Mew System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes No Additional Notes: <br /> VALUATION CALCULATION: Total $ (-,7s O <br /> 004 0 <br /> Approved By ____ '� Date: \d, \, 20\CA <br /> PUBLIC WORKS <br /> Intake OK by: 7.--1`4, Date: .0 .I 0 8 9 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> - Y o��': =OSys Dev Eval OTraffic Mit Eval <br /> a.1b TW Sfax£ 'O Site Work or Drainage Proposed <br /> Approved By \ � Date: pr 3�74j c� =OBackflow Prevention for high hazard: <br /> i(dental,medical,animals,mortuary,hospital, <br /> '\ ;supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferr Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> Fire Sprinklers ' Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑ 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 0 Is located in this folder <br /> Minimal or No Fire Scope-NO FIRE FEE v ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review!Inspection' Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: ( \ Date: /4/,�J/Zcy0 Vii ' blic Works has no scope--- PW Not Re uired <br /> Additional Not • <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />