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5q;$\ �--' 019).10- ©02- /� -o�'l <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT# C V" 112 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Date: <br /> 0 ake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. C7(A1(7I 1 f V1Y. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size /1) 0 cp'Z 0 Hold in Planning File Drawer <br /> Garage/Accessory.Struct.Size 3 Zone \I\I"v <br /> Number of Stories 2, Overlay/Agreement ?Q D <br /> Basement 1FINo ❑Yes , Fin/Unfin Nonresidential Use ------- <br /> Type of Construction Residential Use OM' <br /> Occupancy Group L tiL Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: \ ,�,� <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes IJNo <br /> Reason Sprinklers Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $ aWt 6 € 6G <br /> 1./t/X <br /> Reason Fire Alarm Required: <br /> 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? ❑r Yes ❑No Additional Notes: <br /> CALCULATION: Total$ 53►1•LUATION <br /> 9,0t 1 t2-Ci k WC & Approved By: Date: 1 I 1. 14.0 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PWWorksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Mite Work or Drainage Proposed <br /> DBackflow Prevention for high hazard: <br /> Approved By: -frP "�� Date: +'2,13i/19 (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) ❑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 1RThis 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 Chew System CI Not Req'd A Separatepa PW Permit is Required (Permit#: PW 1q I Z'0Sb ) <br /> Fire Alarm: ❑Update Existing ❑New System Elr <br /> Not Req'd AND +� Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd ❑ 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 /> Ilk 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: Vv Date: 12 A lvo <br />