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• <br /> • <br /> Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# k log -a <br /> BUILDING ! PLANNING ,i <br /> Intake OK by: lee' Date: ` / Intake OK by: Assign To: Date:v1/I45/I I <br /> Intake Comm:': 4 Intake Comments: / <br /> 4 ein-fic Se4britr/e-C OE eq(AlOnatni- <br /> v' 1c&i e . <br /> o Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building 0 Route to Historic Reviewer <br /> 0 Make this a"W"Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size 1, Zone =3 <br /> Number of Stories Overlay/Agreement CI Inrc tj&tate + Care keS. <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yeso <br /> Reason Sprinklers Required: "In Lie?nt-E_e ype: rr6Gnt$ _ <br /> Fire Alarm: El Update Existing ❑New System El Not Req'd School Impact Fee: <br /> Reason Fire Alarm Required: Calculated: Cre ' : <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No 0 School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ S+?P.ccoJl,Yte„S avI r(Gi{I-S <br /> Approved By: 6 Date: It/LI! '/I <br /> S 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 /> ❑Site Work or Drainage Proposed <br /> Approved By: irp Date: t j E4 14 i❑Backflow Prevention for high hazard: <br /> i(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 /> El Fire Sprinklers El Fire Alarm DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> �^ <br /> V l oi re AA r`e_A. ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: U 0 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 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: IP Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: 140, Date: Off <br />