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Intake & Approval Sheet (FOR PERMIT STAFF ONLY PERMIT # <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />BI I/Addn/Rem Size <br />2 *7 SiC. <br />arage ccesso Struct. Size <br />-7 S5' ? 2 c7 <br />Number of ories <br />Basement <br />RNo ❑Yes , Fin / Unfin <br />Type of Construction <br />R <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing El System El Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No <br />Add'I RCW 64.55 docs required priorto final? ❑Yes ONo <br />VALUATION CALCULATION: Total $ 4/7i 573 <br />Additional Notes: Z,0/!57 14C JAVSEC, <br />Approved By: Date: 7/27 ZO <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />gFire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />11 Review of As -Built Plans - NO FIRE FEE <br />Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Assign To: Date: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />❑ _OK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone - .1 <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />Alit snz- <br />Proposed No. of Dwelling Units, <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? Yes []No <br />"In Lieu" Fee: Type: Amount $ <br />School Impact Fee: Total $ <br />Calculated: 14 `ISO Credit: <br />Zverett School Dist ❑Mukilteo School Dist <br />Additional Notes: A ft AW Q/L e6i (A co�d <br />666,2� tqac+- k%L (tq OAAA t IngOA&N Ireq <br />Approved By: Date: 1b , q, 207 0 <br />PUBLIC WORKS <br />Intake OK by: Date: <br />..... ..... ........ ......... .... ............ ................................... ......... ... _......,..,.......................... .... .............. <br />Intake Comments: PW Worksheet Needed if: <br />:[]Sys Dev Eval OTraffic Mit Eval <br />❑Site Work or Drainage Proposed <br />ElBackflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />.supportive housing) <br />....................... ..... .............................................................. .............. ....,........................ ..................... <br />❑ Route this folder for PW Review at end --- PW Review Worksheet <br />[]This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />WSee PW Review Worksheet and associated attached items <br />IA Separate PW Permit is Required (Permit #: PW 20 10 -O # 7) <br />AND M-Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance), <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: Date: fi b <br />