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0 TI <br /> Intake rov Sheet (FOR PERMIT STAFF ONLY) . PERMIT# j ZDb -b 2� <br /> BUILDING PLANNING <br /> ,�. / t 1 � .. (/r6/2-G <br /> Intake OK by: ;� Date: tej�r2�t, Intake OK by.�/, b Assign To: Date: <br /> Intake Commen i Intake Comments: <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 1 bt cD Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone C <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No DYes , Fin/Unfin Nonresidential Use Q ce, <br /> Type of Construction 1r— A Residential Use <br /> Occupancy Group i?j Proposed No.of Dwelling Units: <br /> Occupancy Load IR(Q Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes <br /> Reason Sprinklers Required: "In ieu"Fee:Type: Amount$ <br /> Fire Alarm: 13Update Existing ❑New System El Not Req'd School Impac • Total <br /> Reason Fire Alarm.Required: 1�1 Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes No ❑Evere c ool Dist ❑Mukilteo of Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes Ip.I No Addi ional Notes: NO t/� I"'*Iee � i, O( eAnce � <br /> VALUATION CALCULATION: Total$ L00, odD A a non� Anh .t11 ,5 ve,-a4 r <br /> _ Approved By:V f Date: 2/ )4/� <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> I❑Sys Dev Eval ❑Traffic Mit Eval <br /> DSite Work or Drainage Proposed <br /> Approved By: Date: 2 poi� 2e1� DBackflow 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 OFire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ,17D S/ io 4t-a-5 ❑This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: S.C6 1�k Date: '/2/ tow Public Works has no scope---PW Not Required <br /> Ad itio tes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />