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• <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLI) <br />• <br />PERMIT # L--1 O ` )— <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />_ <br />Number of Stories <br />/ <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />o2 `� <br />Fire Sprinklers: []Update Existing ❑New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: Update Existing ❑New System []Not Req'd <br />Reason Fire Alarm Required: L I I d/rL_ ,f'T S <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes In No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes 1ZNo <br />VALUATION CALCULATION: Total $ 7 `-(.3 <br />Additional Notes: <br />Approved By: Z14_!, � Date: �; f <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />il_� <br />UFire Sprinklers Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />Review / Inspection Scope - ADD FIRE FEE <br />Approved Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />p <br />Intake OK by Assign To: f�-_ Date. <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ ute to Historic Reviewer <br />OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? []Yes ❑No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: Credit: <br />❑Everett School Dist ❑Mukilteo School Dist <br />Additional Notes: <br />�I <br />vv;J*t-Wi►T per,,i,-r. <br />Approved By: Date: <br />PUBLIC WORKS <br />Intake OK by: Date: <br />..........................................................,.........,...........,.,,..,..,,.,.,,,.,,,...,.............................,,,................ <br />Intake Comments: PW Worksheet Needed if.• <br />El Sys Dev Eval ❑Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />,(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />'t.......................................................................................................................... <br />El Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously []Deferred <br />❑ This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: Date: <br />/ <br />