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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) • PERMIT# 132151 t' 63 <br /> I <br /> BUILDING- • PLANNINGIntake OK by: Date: Intake OK by:C Assign To: f��!' i 5 Date: 9) /CI'fal <br /> Intake Comments: Intake Comments: <br /> i 7 ,.� <br /> ❑ Route to Commercial Building Attach to Project No. � v 2-0VG " CIAO <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addreem gie 41Z ,5F ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size yes Zone 2-—I <br /> Number of Stories as / Overlay/Agreement ' _ <br /> it Basement ❑No al Yes /Unfin Nonresidential Use <br /> Type of Construction ✓C Residential Use 54 <br /> Occupancy Group 2—3 Proposed No.of Dwelling Units: _ <br /> Occupancy Load 8 Total No.of Dwelling Units: I , <br /> Fire Sprinklers: ❑Update Existing ❑New System Mot Req'd Planning/Lands pe spection Required before Final? ❑Yes 0,k.• <br /> Reason Sprinklers Required: "In Li5u"Fee:T pe: ��\ Amount$ <br /> / <br /> Fire Alarm: El Update Existing ❑New System EINot Req'd Sch of Imps Fee: T al $ <br /> Reason Fire Alarm Required: Calculate . . Credit: v__ ,, \ <br /> RCW 64.55 MF worksheet ❑Yes for d re 'q permit? 0 No ❑Et fit School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ .3 OX,' cX <br /> Approved By. -- v� A.. Date: \. . 202. <br /> ff PUBLIC WoRk8 <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> DSys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> =OBackflow Prevention for high hazard: <br /> Approved By ' „ /Date:o 9/ <br /> \}— ' 3(dental,medical,animals,mortuary,hospital, <br /> Zeu (supportive housing) <br /> FIRE DEPARTMENT DRoute 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 OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> Additional Notes: ❑This Permit is Approved by Public Works '' <br /> 0 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 0 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: Fr 'ublic Works has no scope---PW Not Required <br /> Additional Notes. i i 1 4 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 2-E- <br />