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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 1j(,(9 (q( 61-11) <br /> BUILDING PLANNING <br /> Intake OK byf -4. Date: l/.)01l9. Intake OK by: .�,11 Assign To: tj( Date: 1).14.)i <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/TI/Addn/Rem Size (eo jF Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories j Overlay/Agreement _ <br /> Basement MNo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction ( Residential Use digWieeet <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load (J,/.4 Total No.of Dwelling Units: <br /> Fire Sprinklers: CI Update Existing ❑New System Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: CI Update Existing El New System Mot Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes RNo ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ICNo Additional Notes: <br /> VALUATION CALCULATION: Total$ gs- <br /> Approved By: MS Date: 3/(a /20 <br /> PUBLIC WORKS <br /> Intake OK by:"ta Date: it 4 ei <br /> Additional Notes: 'Q/5- /ke . W S6c Intake Comments: PW Worksheet Needed if: <br /> 'VI a2- 4) <br /> 4.- .N/-.O'"... L•"t <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: �!Date:� pQ =OBackflow Prevention for high hazard: <br /> "`•••qqq((( !!! i(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT El Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(loin 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: Public Works has no scope---PW Not Requir <br /> Additional Notes <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: / <br />