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STAFF ONLY) PERMIT# O Oa <br /> • • <br /> Intake &Approval Sheet (FOR PERMIT CVO`� g" <br /> BUILDING `� PLANNING <br /> Intake OK by: V H' Date: S fL2,//' Intake OK by: V 1V" Date:- 2 _241 <br /> Intake Comments: Intake Comments: Assign To: 1S-6‘.1 <br /> Mi3Si S- Gtc - clfi' elStrtf ins4 to(GtyL- <br /> t 04.0 t' ac.9561 crrl cS/Se41 <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> iit'Route to Residential Building ❑ Route to Historic Reviewer <br /> Make this a"W"Permit $.OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 29 1 Z $P. 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size •er. Zone 12--2- <br /> Number of Stories 2_. Overlay/Agreement <br /> Basement ❑No ®.Yes , Fin Unfin Nonresidential Use —" <br /> Type of Construction ? Residential Use S I2- <br /> Occupancy Group Q Proposed No.of Dwelling Units: — <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing El New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 'No <br /> Reason Sprinklers Required: "In Lieu" •Type: ount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: I $ <br /> Reason Fire Alarm Required: Calculated: edit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes xi No ❑Eve chool Dist ❑Mukilteo Scho ' t <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ra-No Additional Notes: A1't"' A ► CYO 0.5 <br /> VALUATION CALCULATION: Total $ lit S6oc) <br /> Zci 12. sig. € S-o/tF. <br /> Approved By: •1103,1Date: 1`- )- Iq <br /> PUBLIC WORKS <br /> Intake OK by: "nisi Date: ? J2Zf 20 t t <br /> Additional Notes: 2_0/S' /R.G it kt)Sly L Intake Comments: PW Worksheet Needed if: <br /> I,.a'tEc�,s ci RL ibb%,4k 'wvs Sys Dev Eval ❑Traffic Mit Eval <br /> LN A.i LSE io R-ooc� ❑Site Work or Drainage Proposed <br /> 040:.Approved By: Date: L7iza he, o Foote f�,..-r ElBackflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT 174oute 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 /> El Fire Sprinklers OFire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 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: TA Public Works has no scope---PW Not Required <br /> Additional Notes: !6 /23/Z-0 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />