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11111 <br /> Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) PERMIT#g)t, OZ-O3g <br /> BUILDING > l�/^ PLANNING <br /> Intake OK bye .7% Date:0�//S/ZO/9 Intake OK by: Date: e/1L <br /> Intake Comments: Intake Comments: Assign To: 61-14 <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ 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 32 $',F ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size � Zone _ C <br /> Number of Stories Overlay/Agreement <br /> Basement I,? No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction s Residential Use fz <br /> Occupancy Group 12 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 {Vo <br /> Reason Sprinklers Required: "in i ee:Type: A <br /> Fire Alarm: ❑Update Existing El New System El Not Req'd School Impact Fee. otaf $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 ME worksheet req'd for permit? ❑Yes NI No ❑E School Dist ❑Mukilteo Sc ist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes IgNo Additional Notes: rf ia'1,'o ni()Cireforti " pa (M <br /> VALUATION CALCULATION: Total$ 2336 Aptly re. awaT pare; 5 <br /> Approved By: Date:6 1/i <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: 20 `S SgC. Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By: Date:10// /P9 ❑Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑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 /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes. • ❑This Permit is Approved by Public Works <br /> h.bi" 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑A Separate PW Permit is Required (Permit#: PW ) <br /> ❑ Review of As-Bu. lans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Revi /Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> A roved By: Date: Public Works has no scope---PW Not Required <br /> dditional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: 7-3-e,/t7/4—,_, Date: (:).?e <br /> �' v <br />