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Intake &Approval Sheet *(FOR PERMIT STAFF ONLY) 0 PERMIT#'Z/e)'6 — C).l <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:a� Assign To:f to . Date: (0/0/2-024 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W"Permit WOK to Route to Other Departments <br /> Bldg/TI/Addn lia, 7l/9 kr/. ❑ Hold in Planning File Drawer <br /> Garage/Accessory ruct.Size Ye5 Zone 1L 2. <br /> Number of Stories / Overlay/Agreement <br /> Basement ❑No IYes, Fin/Unfin Nonresidential Use <br /> Type of Construction .f/ Residential Use Sr 12- <br /> Occupancy Group /46_ 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 No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type:_ Amount$ <br /> Fire Alarm: El Update Existing El New 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$ /2/ 7 C.V. w <br /> Approved By: aitSDate: (1/01 /.2.014 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> €DSys Dev Eval ❑Traffic Mit Eval <br /> `DSite Work or Drainage Proposed <br /> Approved By _©Backflow Prevention for high hazard: <br /> A Date;0 0,602.4e <br /> .,..49t4----, I <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/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 /> • <br /> Additional Notes: a ❑This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 0 A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> vlinimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:Z f KCnuo n Date:a 77-,2/ ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> ZI <br /> Z <br />