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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Y ` -} I <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: (.� lS Assign To: �� �. Date:21t1 2✓ <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 [,g OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem SizeO( 4 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories I Overlay/Agreement <br /> Basement INo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction V 13 Residential Use <br /> Occupancy Group r. . Proposed No.of Dwelling Units: <br /> Occupancy Load Ci Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing Chew System 1Yot 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 ew 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 DEverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes o Additional Notes: <br /> VALUATION CALCULATION: Total$ P/O O. 6 ' <br /> 1c h <br /> /RAN\ affroV . <br /> Approve By: I Date: <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPWWorksheetNeededif:: <br /> $DSys Dev Eval OTraffic Mit Eval <br /> Pi <br /> iDSite Work or Drainage Proposed <br /> Approved By: �'�_ �" Date /�� 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 /> ❑Fire Sprinklers ❑Fire Alarm DOther: AND ❑Create Green Folder OSubmitted Previously ❑Deferred <br /> Additional Notes: J4his Permit is Approved by Public Works <br /> IB.See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: 2-A Separate PW Permit is Required(Permit#: PW 22.62—012 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Efts located in this folder <br /> gMinimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> view/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> /! <br /> Approved By: , tr ( j j C Date: �':./q-2,,1 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved Bje.2. --e,/.-4.. Date: ¢I I2r2 2t. <br />