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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 06 1 4 ON <br /> BUILDING PLANNING <br /> Intake OK by: Date: 712 11.....W <br /> r3M Intake OK by: r W Date: --/—/ Z <br /> Intake Comments: Intake Comments: Assign To: 1'�. <br /> tie Cor . •,v- Wz, ,s felM <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> N'Route to Residential Building 0 Route to Historic Reviewer <br /> 1t Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Add Re Size j p' elaki 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone Z <br /> Number of Stories Overlay/Agreement <br /> Basement 1 No ❑Yes , Fin/Unfin Nonresidential Use <br /> Type of Construction 'tT3 Residential Use /,1,C. <br /> Occupancy Group Proposed No. of Dwelling Units: 1` 1 <br /> Occupancy Load Total No. of Dwelling Units: Z <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes 15< <br /> Reason Sprinklers Required: "In Lieu" Fee: Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact F/eee: Total $ 'll 2� (eq J,C <br /> eck <br /> Reason Fire Alarm Required: Calculated: 1`bl Z50 Credit: el12 -- <br /> RCW 64.55 MF worksheet req'd for permit? DYes J,`��,', }'No I kverett School Dist DMukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes I�,No Additional Notes: <br /> 110.61 <br /> VALUATION CALCULATION: Total$ <br /> Approved By: 1 rj 14,1 Date: 47 C ./ ; i'- ,.a <br /> PUBLIC WORKS <br /> Intake OK by: Date: " di <br /> Additional Notes: Z o /S /2C Et IIS'c___ Intake Comments: PW Workshget Needed if: <br /> .1012 s�F ro 4 ys Dell file ' <br /> , Sys Dev Eval ❑Traffic Mit Eval <br /> har-rl Sur ACE,. j�Site Work or Drainage Proposed 3€ <br /> 13 <br /> Approved By: (Clfr Date: S/1072.0 aJi7%t-/I' / ,4 �Backflow Prevention for high hazard: <br /> J' (dental,medical,animals,mortuary,hospital, <br /> St/eh -I-,-S'w S1d bet//E6 _ supportive housing) <br /> FIRE DEPARTMENT rdRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate I 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 /> ,l See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 1 A Separate PW Permit is Required (Permit#: PW 2010 - all ) <br /> 0 Review of As-Built Plans-NO FIRE FEE AND El Is located in this folder <br /> 0 Minimal or No Fire Scope- NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> 0 Review/Inspection Scope-ADD FIRE FEE 0 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 By: ,-\ Date: to) ( 2. <br />