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Intake &Approval Sheet • (FOR PERMIT STAFF ONL• PERMIT# a 160 J— CAI <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: ( Assign To _ Da� its___ <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 /> O Make this a"W"Permit OK to Route to Other Departments <br /> Bld /TI/Addn/Rem Size 0 Hold in PlanningFile Drawer <br /> g �-�-'�" <br /> Garage/Accessory Struct.Size — Zone C— <br /> Number of Stories i Overlay/Agreement <br /> Basement �No ❑Yes , Fin/Unfin Nonresidential Use \ (yv? vr-I--- re-fri, <br /> Type of Construction v' Residential Use <br /> Occupancy Group IA Proposed No.of Dwelling Units: ____ ____ <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing ❑New System 'Not Req'd P nning/Landscape Inspection Required before Final? ❑Yes No <br /> Reason Sprinklers Required: "In Lie " ee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System QINot Req'd School Impact Fe . otal $ <br /> Reason Fire Alarm Required: Calculated: -dit�6 <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes n No ❑.F ett School Dist ❑Mukilteo SchooTBist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes VINO Additional Notes:I ri, or ._rAl. 01 , No <br /> VALUATION CALCULATION: Total$ c' rGyreAlve,,/ fi' afPrAiCA W l is it, <br /> Approved By: `r-% ` Date: /31 /2- z_e <br /> Wilk Lro 1, IVl��Nl a " <br /> pry Wv ) fl PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: k c3cp'7� Intake Comments: PW Worksheet Needed if: <br /> ,Futg im,sr c s Ra,`r 4.i cs- 'Ft e.-2 ❑ <br /> e--T Sys Dev Eval ❑Traffic Mit Eval <br /> ❑Site Work or Drainage Proposed <br /> Approved By: Date:-gam' 1,21¢o}D '❑Backflow Prevention for high hazard: <br /> 4 ;(dental,medical,animals,mortuary,hospital, <br /> _supportive housing) <br /> FIRE DEPARTMENT El 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 ❑Other: AND ❑Create Green Folder ❑Submitted Previously ['Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works s <br /> 0 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 0 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: K.etrvci n Date: 3/ 1 ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />