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L 2- 7sooq <br /> Intake & Approval Sheet a (FOR PERMIT STAFF ONLY) • PERMIT# ,2# 1C�— O <br /> BUILDING ` PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: 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 W../.4 ❑ Hold in Planning File Drawer <br /> Garage/ ccessory Struct. e_ 2 6 4( Zone p_)1 <br /> Number of Stories I. Overlay/Agreement <br /> Basement INo ❑Yess , Fin/Unfin Nonresidential Use <br /> Type of Construction Jf v-J Residential Use SFl-- <br /> Occupancy Group a Proposed No. of Dwelling Units: <br /> Occupancy Load L1 Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System SNot Req'd Planning/Landscape Inspection Required before Final? ['Yes 1lo <br /> Reason Sprinklers Required: "In Lieu"Fee:Ty e: Amount$ <br /> Fire Alarm: ❑Update Existing El New System L1Not Req'd School mpact ee: Total $ <br /> Reason Fire Alarm Required: Calcula d: Cr it: \... / <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes d No ❑Ever chool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 does required prior to final? ❑Yes 'No Additional Notes: <br /> VALUATION CALCULATION: Total$ 'WO <br /> Approved By:A Date:21) l262,4 <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: jPW Worksheet Needed if: <br /> , 1DSys Dev Eval ❑Traffic Mit Eval <br /> I❑Site Work or Drainage Proposed <br /> ❑Backflow Prevention for high hazard: <br /> ��y <br /> Approved B it Date: 0T//40/Z(JZD (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 /> See PW Review Worksheet and associated attached items NIA <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 ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: t Public Works has no scope--- PW Not Required <br /> Additional Notes: 40140, W lescr:6.10 n gii` t <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: i Date: 10/6/U <br />