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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# laZI M ' C15 <br /> BUILDING PLANNING <br /> Intake OK by( • rn2r,. Dater/ 2f Intake OK byCD Assign To: J vl `�J Date: , /..k <br /> Intake Comments: / intake Comments: <br /> ® Route to Commercial Building ❑ 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 /> BI / -/ idn/Rem Size ,1"72O9 7, 0 Hold in Planning File Drawer // <br /> Garage/Accessory Struct.Size ,4/14 Zone L__. h <br /> Number of Stories / Overlay/Agreement I <br /> Basement INo ❑Yes, Fin/Unfin Nonresidential Use \� \/k 14i4 et3aA <br /> Type of Construction t. ,/ (/ Residential Use <br /> Occupancy Group r- i 4`S//U�1 tt"7 Proposed No.of Dwelling Units: <br /> Occupancy Load rl'V Total No.of Dwelling Units: <br /> Fire Sprinklers: -IA pdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required •- ore Final? ❑Yes ❑No <br /> Reason Sprinkles Required: "In Lieu" Fee:Type: Amount$ <br /> Fire Alarm: IrA'kipdate Existing ❑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 n 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 SY363V CO.a <br /> Approve Date: \2 \2 .�Z I <br /> SJ <br /> PUBLIC WORKS <br /> Intake OK by: . Date: __ _ <br /> _ _- <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> Pilv.fth to '• $!o 4- 5 1 s-es,.. <br /> V1Sys Dev Eval ❑Traffic Mit Eval <br /> .nu►*SC.. S�ea......aG. !Mate Work or Drainage Proposed <br /> Approved B DateG' -'P•.o.s 0.04.�.-• =OBackflow Prevention for high hazard: <br /> =(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 /> Fif 1�1 ire Sprinklers .Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> DISee PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ®'A Separate PW Permit is Required(Permit#: PW 2Z0 I -COS-) <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(join with this folderforpermit issuance) <br /> ia Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By:\,9)ce,w,\ Date:1- '1%2,Z ❑ Public Works has no scope---PW Not Required <br /> - <br /> Additional Notes: <br /> ELECTRICAL ' <br /> Additional Notes: <br /> Approved By: Date: Approved By:- --::::- Date: //7 J"ivZZ <br />