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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 0_-‘10 , O v — <br /> BUILDING PLANNING <br /> Intake OK by: V' Date: 8/Z'L(17 Intake OK by:(kb Date: 6/1q/I q <br /> Intake Comments: Intake Comments: Assign To: ► ' WX <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> 10. 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/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone •g' <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use 5 j2. <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? ❑YesIo <br /> Reason Sprinklers Required: "In Lieu"Fee: '.-• Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: To <br /> Reason Fire Alarm Required: Calculated: - <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No 0 - ett School Dist ❑Mukilteo School <br /> Add'I RCW 64.55 docs required prior to final? :hies 0 N Additional Notes: <br /> VALUATION CALCULATION: Total$ '500.-- 1 yds(:Gr KciciAei re.md oL. NO atoll' <br /> S to <br /> ex-{er g`r'r d*. lvu,)d i✓\-q7 . I'vl ee s a l( -+L„acI-S <br /> Approved By:Aj Date: 6M/1 9 <br /> PUBLIC WORKS <br /> Intake OK by: j 41 Date: P I 14 11 4 <br /> Additional Notes: lots" /LC Intake Comments: PW Worksheet Needed if: <br /> [((0 Q.K L-I h f Tro Zo Pa're444,44 le pa y I"-AT«'c.e.- IC- :c,w G.� ❑Sys Dev Eval ❑Traffic Mit Eval <br /> a. '�'E""�� ❑Site Work or Drainage Proposed <br /> 44)Vl lis,4 ,. MO14-16,-42`/0G , fort/AK, <br /> Approved By: Date: 8 ❑Backflow Prevention for high hazard: <br /> Z/� (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate I 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 /> ❑ 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: 14 • olio Works has no scope---PW Not Required <br /> Additional Notes: _____e____1(7, 8 itq ko i t <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: /---....., � <br /> (4,-) <br />