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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# B2 (OS— 02Z <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by:$ Assign To: n ia50413 Date:S113/2o2 4 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 ute to Historic Reviewer <br /> ❑ M this a"W"Permit OK to Route to Other Departments <br /> Bld 1/ ddn/Rem Size ia1 aL 8 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size "t' Zone LF2 <br /> Number of Stories �t / Overlay/Agreement <br /> Basement tlallo ❑Yes, Fin/Unfin Nonresidential Use Wbtr Ifkid <br /> Type of Construction ill 5 Residential Use <br /> Occupancy Group c-- ,S- R Proposed No.of Dwelling Units: <br /> Occupancy Load JC1 Total No.of Dwelling Units: <br /> Fire Sprinklers:TgUpdate 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: -®Update 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 El No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes EINo Additional Notes: <br /> VALUATION CALCULATION: Total$ /5d)6707 <br /> Approved By:a Date:5J,3j?_62_I ` <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: i:PWWorksheet Needed if:- - - <br /> I❑Sys Dev Eval OTraffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Dater /7/i-i <br /> ❑Backflow 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 /> Fire Sprinklers irre Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional otes: 0 This Permit is Approved by Public Works <br /> V <br /> ��(,m I-� 1l 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required (Permit#: PW ) <br /> • <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> O Minimal or No Fire Scope-NO FIRE FEE 0 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: ` -7(j(�y\Date:5-/,g 'f ❑ Public Works has no scope---PW Not Required <br /> '1 Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />