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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# aA.C:kO't- f--02140 <br /> BUILDING <br /> Intake OK by: c..)i Is Date: 1 /i.ct /(1 Intake OK by: wU Date: <br /> Intake Comments: Intake Comments: Assign To: 41 'A' <br /> ❑ Route to Commercial Building ❑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/Addn/Rem Size 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone <br /> Number of Stories Overlay/Agreement <br /> Basement ONo ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use SF-12- <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: I <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: , mount$ <br /> Fire Alarm: ❑Update Existing ONew System ❑Not Req'd School Impact Fee: <br /> Reason Fire Alarm Required: Calculated: d� Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Ev- SchoorDTst ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes.' n less-than t r -f-r. i ( f rC=4JCs7I <br /> VALUATION CALCULATION: Total$ 3 Oao Alt on pr / • <br /> Approved By: so4( Date: 1 /11/1,41 <br /> PUBLIC WORKS <br /> Intake OK by: It.A Date: -7 //q/2c,1ci <br /> Additional Notes: Z Co/,t" 12C. Intake Comments: PW Worksheet Needed if: <br /> I ti�-cc a-to tiz r r N L s%„“, ❑Sys Dev Eval ❑Traffic Mit Eval <br /> Nt0 \i.j ❑Site Work or Drainage Proposed <br /> Approved By: Date:7//i' ,i 9 <br /> DBackflow 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 /> ❑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: jeMblic Works has no scope---PW Not equired <br /> Additional Notes: 7 /l9 /zor <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: �� <br /> I 21_ <br />