319 76TH ST SW T MOBILE ANTENNA 2021-12-30

bI1l6Cg-Od� Intake & Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT #� BUILDING Intake OK by: Date: Intake Comments: ❑ Route to Commercial Building ❑ Route to Residential Building ❑ Make this a "W" Permit Bldg/TI/Addn/Rem Size Garage/Accessory Struct. Size Number of Stories Basement ❑No ❑Yes , Fin / Unfin Type of Construction Occupancy Group Occupancy Load Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Reason Sprinklers Required: Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd Reason Fire Alarm Required: RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No Add] RCW 64.55 docs required prior to final? ❑Yes ❑No VALUATION CALCULATION: Total $ Additional Notes: Approved By: Date: j U FIRE DEPARTMENT Separate / Deferred Submittals Required: ❑Fire Sprinklers ❑Fire Alarm ❑Other: Additional Notes: Fire Dept. Fees: ❑ Review of As -Built Plans - NO FIRE FEE ❑ Minimal or No Fire Scope - NO FIRE FEE ❑ Review / Inspection Scope - ADD FIRE FEE Approved By: Date: ELECTRICAL Additional Notes: Approved By: Date: PLANNING Intake OK by: 05 Date: AT1110l Intake Comments: Assign To: - ve li,fy Vurwtsca��' 0 ❑ Attach to Project No. ❑ Route to Historic Reviewer OK to Route to Other Departments ❑ Hold in Planning File Drawer Zone Overlay/Agreement Nonresidential Use �ni ri F Residential Use Proposed No. of Dwelling Units: Total No. of Dwelling Units: Planning/Landscape Inspection Required before Final? ❑Yes ❑No "In Lieu" Fee. e: Amount $ School Impact Fee: $� Calculated: redit: rett School Dist ❑Mukilteo Sc_h1osl,Dist Additional Notes: Approved By: U Date: 7 PUBLIC WORKS Intake OK by: Date: •----------------------------------------- Intake Comments: ;PW Worksheet Needed if: El Sys Dev Eva ❑Traffic Mit Eval ❑Site Work or Drainage Proposed ❑Backflow Prevention for high hazard: (dental, medical, animals, mortuary, hospital, :supportive housing) '------- --------------------------------- ❑ Route this folder for PW Review at end --- PW Review Worksheet ❑This project also has a separate concurrent PW Review (Green Folder) AND ❑Create Green Folder ❑Submitted Previously ❑Deferred ❑ This Permit is Approved by Public Works ❑ See PW Review Worksheet and associated attached items ❑ A Separate PW Permit is Required (Permit #: PW ) AND ❑ Is located in this folder ❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) ❑ WIII be Issued separately (Separate Green Folder, PW issued ahead of Bldg) L,JjPublic Works has no scope --- PW Not Required Additional Notes:__. &17 Zv/ 9 Approved By: Date: 7i 1