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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) . PERMIT#C CIO E - 022- <br /> BUILDING PLANNING q <br /> Intake OK by• Date: a8/T�� 1 Intake OK by:i� �//Date: 3Qf�q <br /> Intake Comments: Intake Comments: Assign To: 4( <br /> \err 2-m K• is' a(( ,-0 ketcefwYt.. <br /> El Route to Commercial Building ❑Attach to Project No. <br /> Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit %OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 24'3i S"4 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Strucf.Size ZtC S.:6 Zone la-' <br /> Number of Stories 2 Overlay/Agreement <br /> Basement 4crNo ❑Yes, Fin/Unfin Nonresidential Use L� j�/� <br /> Type of Construction T.-'? Residential Use 41 it- {,j/Vi4 ��'" ' " C.. <br /> Occupancy Group r2, A-t. 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 Lj(o <br /> Reason Sprinklers Required: "In Lie e: Amount$ ff <br /> Fire Alarm: ❑Update Existing ❑New System Iii4 Not Req'd School Impact Fee: a <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? Oyes IN No ❑ rett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yees JNo Additional Notes: . <br /> VALUATION CALCULATION: Total$ '!i 1; I <br /> Approved By: 016 Date Z/1212e <br /> PUBLIC WORKS <br /> Intake OK by: Date: 017.3 6 <br /> Additional Notes: (.)J Intake Comments: PW Worksheet 9Veededif: <br /> ErSys Dev Eval ❑Traffic Mit Eval <br /> E ite Work or Drainage Proposed <br /> Approved By: Date: i/2V2,0 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animalortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT MRoute 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 /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Built Plans- NO FIRE FEE AND ❑ 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 ❑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 <br /> Additional Notes: c;e0 Tu2,002Approved By: Date: Approved By: Da e: <br /> 1 <br />