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I <br /> Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY • PERMIT# T 2 `ar-LS <br /> BUILDING PLANNING <br /> Intake OK by: cfilf" Date: /213 Intake OK by: Assign To:G CACe Date: IZ! L/! <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building IF] Attach to Project No. '(E\ \°\,-O JQ) <br /> fir Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit WOK to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Sized 50 Zone (z--Z. <br /> Number of Stories / Overlay/Agreement <br /> Basement ,T No ❑Yes , Fin/Unfin Nonresidential Use — <br /> Type of Construction Residential Use S(-'" - <br /> Occupancy Group U Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes I o <br /> Reason Sprinklers Required: "In "Fee:Type: nt$ <br /> Fire Alarm: ❑Update Existing [hew System El Not Req'd School Impact Fee: �utl <br /> Reason Fire Alarm Required: Calculated: Cre I . <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes "No ❑Eyar School Dist ❑Mukilteo School Dist — — <br /> Add'I RCW 64.55 docs required prior to final? .❑Yes RNo Additional Notes: <br /> VALUATION CALCULATION: Total$ Lei 648 <br /> Approvedki Date: t-CS �Zc <br /> �' PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Z 3/e3' / e C_ Intake Comments: =PW Worksheet Needed if: <br /> c _ l�Sys Dev Eval ❑Traffic Mit Eval <br /> ffWilg .6 F/�� i Site Work or Drainage Proposed <br /> Approved By: Date: /IZZ �� A',ZC` " `t =❑Backflow Prevention for high hazard: <br /> �G�C <br /> /Q wia A(dental,medical,animals,mortuary,hospital, <br /> 4 Isupportive housing) <br /> FIRE DEPARTMENT L�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 /> DFire Sprinklers DFire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: is Permit is Approved by Public Works <br /> asee PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: igi-A Separate PW Permit is Required (Permit#: PW 2,001 -O2 5 ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Ig-ts-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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: OF/7 7/ tea <br />