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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# v3[9.0(-003 <br /> BUILDING ) PLANNING <br /> Intake OK by: Date: 1[25p�(p Intake OK b Date: t. 1—ZOI <br /> Intake Comme ts: Intake Comments: Assign To: ca ' • <br /> \at cec\--AAs A,e`2� <br /> � <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> O Make this a"W" Permit 14 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/ ccessoryS ruct. Size 232_ S1 - Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No DYes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use Sr <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: CAk <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not t3ect!d„ Planning/Landscape Inspection Required before Final? ❑Yes ®No <br /> Reason Sprinklers Required: Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New S ❑Not Req'd Sch of Impact Fee: Total $ ------- <br /> Reason Fire Alarm Required: Calc lated: { Credit: <br /> RCW 64.55 MF worksheet req'd for permi ❑Yes 0 No ❑E erett School Dist1 ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to n I? ❑Yes ❑No Add. ional Notes: •FIVq Z-CACAO'5 Z`GL\OLA <br /> VALUATION CALCULATION: TO al $ V S �G�. � A ')0; t cAcAosZ\O'-\©' <br /> Approved I c---J Date: 17): <br /> .�,'y�Z e--(1)\C PUBLIC WORKS <br /> Intake OK by: T Date: I/.4:51// <br /> Additional Notes: uk,a, ety vs,:l tAt� -b Intake Comments: PW Worksheet Needed if: <br /> Fl C*.),1-c cLr -tes(AvA blew -0E G,� Sys Dev Eval ❑Traffic Mit Eval <br /> CV� v E: �o <br /> d,o -9r p� ,-r Site Work or Drainage Proposed <br /> B c-Av6 , ❑Backflow Prevention for high hazard: <br /> Approved By: �� Date: 1rf ( ' s �F ss <br /> j %,•4N� Z0 p (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT E 'flute this folder for PW Review at end ---PW Review Worksheet <br /> Intake: (Needed for Townhomes,Alley load SFR,New Commercial) ❑This project also has a separate concurrent PW Review(Green Folder) <br /> ❑Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project Team 0 This Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 0 See PW Review Worksheet and associated attached items <br /> Fire Sprinklers: ❑Update Existing ❑New System 0 Not Req'd 0 A Separate PW Permit is Required (Permit#: PW ) <br /> Fire Alarm: ❑Update Existing ❑New System 0 Not Req'd AND ❑ Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System ❑ Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes: 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 /> Additional Notes: <br /> ELECTRICAL DocAc ary i evvIntelk. <br /> Additional Notes: <br /> Approved By: Date: Approved By: AecIA- Date: ///g/UI9 <br /> -ig <br />