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0 <br />Intake & Approval Sheet (FOR PERMIT STAFF ONLr <br />PERMIT #�'2Z©2' 045 <br />BUILDING <br />Intake OK by;- . Y' - Date: 0 Z L47' <br />Intake Comments. <br />Route to Contrnsrct Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Add /hem ize <br />/ 7 F <br />Garage/Accessory Struct. Size <br />A11 <br />Number of Stories <br />Basement <br />®No ❑Yes , Fin / Unfin <br />Type of Construction <br />4E—,6 <br />Occupancy Group <br />%" <br />Occupancy Load <br />Fire Sprinklers: —]Update Existing ❑New System Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: pdate Existing El New System El Not Req'd <br />Reason Fire Alarm Required: <br />�f <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ® No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes av0 <br />VALUATION CALCULATION: Total $ 6700-IZ. 00 <br />Additional Notes: <br />1 <br />Approved B - Date: e '01 <br />U <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ire Alarm El Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ 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: 3- 3":._9C,� <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />r <br />Intake OK by: Assign To: Date: 0 <br />Intake Comments: <br />❑ Attach to Project No. <br />to Historic Reviewer <br />���❑J2oute <br />C OK to Route to Other Departments <br />bHold in Planning File Drawer <br />Zone <br />— <br />Overlay/Agreement <br />Nonresidential Use <br />I j <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes No <br />In Fee: Fee: Type: Amount $ <br />School Impact Total $ <br />Calculated: edit: <br />❑Evere ooI Dist ❑Mukilteo School I <br />Additional Notes:. I K _ /v 0 (�1� <br />�t^� Gl� W � Y (V � LcTI /7 <br />Approved By: /A,/" Date: 777-�; 2_Cl <br />PUBLIC WORKS <br />Intake OK by: Date: <br />................... .......... <br />Intake Comments:PW Worksheet Needed if.• <br />.[]Sys Dev Eval ❑Traffic Mit Eval <br />❑Site Work or Drainage Proposed <br />❑Backflow 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 />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder (join with this folderfor permit issuance) <br />❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />12 Public Works has no scope --- PW Not Required <br />Additional Notes:----- I__. <br />Approved By: Date: <br />