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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# C��61 'OOl <br /> BUILDING PLANNING � <br /> Intake OK by: � U Date: vci/( � Intake OK by: V Date: Q I 1/ <br /> Intake Comments: Intake Comments: Assign To: A� <br /> �D into an(1 cavi o of <br /> req vl e v i-�`. <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> IKE Route to Residential Building ❑ -oute to Historic Reviewer <br /> ❑ Make this a"W"Permit Pl I K to Route to Other Departments <br /> Bldg/TI/Add 4 Size 353 Sic' 0 Hold in Planning.File Drawer <br /> Garage/Accessory Struct.Size 2.q7 S, Zone <br /> Number of Stories 2- Overlay/Agreement <br /> Basement ONo lElYes, Fin _iir_ Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group 1 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 ❑No <br /> Reason Sprinklers Required: "In " ee:Type: Amoyta#-$'r <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: - $ <br /> Reason Fire Alarm Required: Calculated: -dit: <br /> RCW 64.55 MF worksheet req'd for permit? DYes 0 No • -` School Dist ❑Mukilteo Schoo <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 341/3.43 <br /> Approved By: / Date: ai <br /> 240i. r(-000- VI ,ITA g PUBLIC WORKS <br /> t- tG,HT 1-6-5c 7rAA&) /41 Intake OK by: Date: e s <br /> Additional Notes: 2)7 I ((LC (A)S'{'C Intake Comments: PW Worksheet eeded if:: <br /> WSys Dev Eval? ❑Trafhc Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date:g123/11 ❑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 /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> ,meq See PW Review Worksheet and associated attached items <br /> a <br /> Fire Dept. Fees: d A Separate PW Permit is Required (Permit#: PW J'1O 9-06, <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 41 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: ?//z//q <br />