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Intake & Approval Sheet <br />(FOR PERMIT STAFF ONLY) PE IT # <br />Q,kak2,0C22 <br />BUILDING <br />Intake OK b . A- Date: fZ /� 'tom/C( <br />Intake Commen <br />❑ Route to Commercial Building <br />Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/T ddn/ em Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />Wlo ❑Yes , Fin / Unfin <br />Type of Construction <br />S <br />Occupancy Group <br />/e <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System MNot <br />Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing El New System J3Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes IN No <br />Add'I RCW 64.55 docs required prior to final? []Yes ®No <br />VALUATION CALCULATION: Total $ <br />26q,s 0�a <br />Additional Notes: « //2L 10� UIIS'09c_ <br />Approved By: Date: LaJ'r 2 11 <br />- FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑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: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLA NG <br />Intake OK by Assign To: Ei Date: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ oute to Historic Reviewer <br />K to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />�"— <br />Nonresidential Use <br />Residential Use <br />SEE <br />Proposed No. of Dwelling Units: <br />— <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required bef re Final? ❑Yes o <br />"In Lie :Type: Amount $ <br />School Impact Fee: <br />Calculated: dit: <br />❑ eft School Dist ❑Mukilteo Sc <br />Additional Notes: <br />Approved By: Date: 3c) <br />PUBLIC WORKS <br />Intake OK by: Date: <br />Intake Comments: PW Worksheet Needed if., <br />y� :)Sys Dev Eval ❑Traffic Mit Eval <br />�' /" 1�Site Work or Drainage Proposed <br />/ I1113ackflow Prevention for high hazard: <br />,(dental, medical, animals, mortuary, hospital, <br />'supportive housing) <br />[YRoute this folder for PW Review at end --- PW Review Worksheef <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 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: :10 <br />