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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# rJ( 017 'CO? <br /> BUILDING PLANNING -7 � <br /> Intake OK by: Date: 7/' J,'? Intake OK by: C Date: / / 1/i 1 I <br /> Intake Comments: Intake Comments: Assign To: y1 <br /> O Route to Commercial Building 0 Attach to Project No. <br /> Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addr>(remT��'ize "7 404 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement IZINo ❑Yes, Fin/Unfin Nonresidential Use / <br /> Type of Construction 24a Residential Use e rt.Aro <br /> Occupancy Group . 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 to <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 0 No ❑Eve = chool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0 No Additional Notes: <br /> VALUATION CALCULATION: Total$ SS <br /> Approved By: a Date: 7 /9/11 1/ 101 <br /> PUBLIC WORKS <br /> Intake OK by: 15-5 Date:_ <br /> Additional Notes: 2a/tr l t& Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: cJ'I Date: 71419 ❑Backflow Prevention for high hazard: <br /> (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: 0 A Separate PW Permit is Required (Permit#: PW ) <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 /> O 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 Required <br /> dditional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> Z <br />