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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# Mfba47Ib% <br /> BUILDING PLANNING <br /> Intake OK by: <itDate: (2—//. /` Intake OK by: � '� Date: <br /> Intake Comments: Intake Comments: Assign To: <br /> ❑ Route to Commercial Building 0 Attach to Project No. `\E I \°\- (©\ _ <br /> � <br /> Route to Residential Building <br /> Make this a"W"Permit 0 Route to Historic Reviewer �'GUi•t�✓ <br /> On /2//2/*. OG -/ <br /> 0 OK to Route to Other Departments inyeti/. J �7-- <br /> Bldg/TI/Addn/Rem Size r-XIST , 0 Hold in Planning File Drawer -fiele puns. AktSc yLvi <br /> .. Garage/Accessory Struct.Size EA,/Syl‘r _ Zone i2- I <br /> Number of Stories 1 Overlay/Agreement AIOAJE <br /> Basement ❑No RlYes, In Unfin Nonresidential Use <br /> Type of Construction n Residential Use blot+ S*V k b&C& kW <br /> - <br /> Occupancy Group � Proposed No. of Dwelling Units: SfQ 4- pc <br /> Occupancy Load Total No. of Dwelling Units: Z.`o& VV.1 k hdrot <br /> Fire Sprinklers: ❑Update Existing Chew System <br /> ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes MNo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: Total $________.______----------m' <br /> Reason <br /> - <br /> Reason Fire Alarm Required: Cal ulated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes IR No rett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes C3No AdditionalritNotes: ,�_A� A,^,1 <br /> VALUATION CALCULATION: Total$ { (C�cte. Ca �' Q'Jiti ).M <br /> Approved I - Date: - _CY_9,LO\9.... <br /> PUBLIC WORKS <br /> Intake OK by: Tr1 Date: /2/ 72_/7-o e$ <br /> Additional Notes: 20/5- MC.. ft id-S- Intake Comments: PW Worksheet Needed if: <br /> --e®ti,,,cre..r- 13.Asa�,,,3,-T Ilras Dev Eval ISTraffic Mit Eval <br /> -rt) a.D•D OSite Work or Drainage Proposed <br /> Approved By: Oetolk 4. Date: i2Atg IIl ..gas 'P v€L-o4ME�-�-c "..s <br /> ❑Backflow Prevention for high hazard: <br /> AAOta,,�'v� (dental,medical,animals,mortuary,hospital, <br /> IMO 3e- eo L--- -c-r=o RFzr` supportive housing) <br /> tuzs- o f K`Act. <br /> FIRE DEPARTMENT Route 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 /> El Route to Fire Drawer---Fire Preliminary Review Notice AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> ❑Sending Fire Notes to Project TeamThis Permit is Approved by Public Works <br /> Date: (OK to Route to Other Departments) 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 0 Is located in this folder <br /> Chemical Sup: ❑Update Existing ❑New System 0 Not Req'd 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> Additional Notes:Ad VI 4 ❑ 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 ',to -T-2arcf,c- •-r 0V- sYs1:4v. rC. s <br /> Additional Notes: a�.at c _ <br /> Approved By: Date: Approved : Date: 0"2iPi <br /> 1 <br />