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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 1O t—Cr2_, <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: /MS <br /> n,. ^ Assign To: 0 Date: 1 1 d 1.0 e r <br /> Intake Comments: Intake Comments':w 1 <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ral OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone — Z <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Mew System ❑Not Req'd Planning/Landscape Inspection Requ' -. •efore Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lieu".Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing [New System El Not Req'd School Impact --: • al $ <br /> Reason Fire Alarm Required: Calculated: it:�,__ <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑E = ett School Dist ❑Mukilteo SchoollJlst-- <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 2i 90g.a0 <br /> Approved By: 241 <br /> Date: 1 /1/0/ 2v2_63 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: =PW Worksheet Needed if: <br /> 3❑Sys Dev Eval ❑Traffic Mit Eva! <br /> ❑Site Work or Drainage Proposed <br /> Approved By:(, Date• p///0/7,02,0ICIBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> ;supportive housing)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 El 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 /> O Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> O 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: RZ--- <br /> _ ` <br />