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• • oa 22 t <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# �Z 3 03 ( <br /> BUILDING PLANNING <br /> Intake OK by: CJ41,y Date: 3/2720 Intake OK by: Assign To: Date: ,� Z20 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> ❑ Make this a"W" Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 12_ sr Zone (Z—2- <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction 'CLP Residential Use SF-p. <br /> Occupancy Group C.A Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Plannin /Landscape Inspection Required before Final? ❑Yes 'lo <br /> Reason Sprinklers Required: "In Lieu" Fee: • amount$ <br /> Fire Alarm: ❑Update Existing ❑New System El Not Req'd School Impact Fee: Tota <br /> Reason Fire Alarm Required: Calculated: / Cre I . <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes I®7 No ❑Ever chool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes �.a�No Additional Notes: <br /> VALUATION CALCULATION: Total$ I I SS <br /> 2I @ 25 515- <br /> Zl e 30 3o Approved By: Date: 3/2/2e <br /> PUBLIC WORKS <br /> Intake OK by: Date <br /> Additional Notes: Z 0 r$ /2L Intake Comments: !PW Worksheet Needed if: <br /> C-ov ;` ') -13 �1"6 " S IOSys Dev Eval ❑Traffict Mit Eval <br /> 33•Zs- S� €❑Site Work or Drainage Proposed—w <br /> Approved By: </f f' Date:3JZY/Z0 A•vp -rsD„.4.4 s,o)T o-r ❑Backflow Prevention for high hazard: <br /> -r L�� ?E��� - i(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENTffoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: OThis 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 /> fa-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 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: 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved Bye+ / ��l Date: c+ 10 4, / .0�r <br />