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Intake & Approval Sheet • FOR PERMIT STAFF ON09 a PERMIT # og - 02­ <br />BUILDING <br />Intake OK b <br />Intake Comments: <br />❑ Route to Commercial Building <br />Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI /Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />WNo ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: El Update Existing ❑New System KNot Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: ❑Update Existing ❑New System ONot Req'd <br />Reason Fire Alarm Required: <br />VT <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes N No <br />Add'I RCW 64.55 docs required prior to final? ❑Yes ®No <br />VALUATION CALCULATION: Total $ 2( -%� <br />Additional Notes: ZD/j /�LiGjjS <br />Approved By. Dat ` 3 <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />El Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept. Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review / Inspection Scope - ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date: 12,all 0 <br />r <br />Assign To: <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ oute to Historic Reviewer <br />K to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />— <br />Overlay/Agreement <br />Nonresidential Use <br />Residential Use <br />j ( ' <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? AYes 6.10 <br />"In Lieu" F T pe: Amount $ <br />School Impact Fee: $ <br />Calculated: <br />❑Ey chool Dist ❑Mukilteo School i - <br />Additional Notes: Lgr1,rJSC6tCj✓L I�tS�L G✓l <br />�n CGcIr��/SVIGs6I �e m tv wee+ SVtC✓+ <br />La+ & Ury 0 <br />Approved By: Date: 0 7f12,4 <br />PUBLIC WORKS <br />Intake OK by: `'6 Date: 0�6 <br />Intake Comments: ;PW Worksheet Needed if.• <br />Dev Eval ❑Traffic Mit Eval <br />;Sys <br />�GG :NLSite Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: :(dental, medical, animals, mortuary, hospital, <br />:supportive housing) <br />: ----------------------------------------- <br />Route this folder for PW Review at end --- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder [Submitted Previously ❑Deferred <br />This Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit #: PW f,oc C,Z 3 ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qoin with this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope --- PW Not Required <br />Additional Notes: <br />Approved By: <br />Approved r <br />