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0 • <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# .1 l't Og-O55. <br /> BUILDING PLANNING <br /> Intake OK by: Date:�12� ' Intake OK by: Ci Date: e�Z� Z <br /> I <br /> 1 <br /> Intake Comment . Intake Comments: Assign To: <br /> I iiRdSCO10 <br /> 1 iv1S - a4 rcqu <br /> ❑ Route.to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit S OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories Overlay/Agreement (i) Q <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use Cl[ti C <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: DUpdate Existing ❑New System ❑Not Req'd Planning/ dscape Inspection Required before Final? ❑Yes to <br /> Reason Sprinklers Required: "In Lieu"Fee:Typ <br /> Fire Alarm: El Update Existing ❑New System ❑Not Req'd School Impact Fee: Total <br /> Reason Fire Alarm Required: Calculated: Credi . <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Ev chool Dist DMukilteo School Dis` <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ 7-c5.i°4ri) \ <br /> Approved By: V V Date: I01 r 1/9 <br /> PUBLIC WORKS <br /> Intake OK by: . . Date: 9(2,3 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ,�/ Sys Dev Eval ❑Traffic Mit Eval <br /> ,,, <br /> 1 ��.��` ��� , �D.�`. ��Q fil}�G'TLe�� ��, DSite Work or Drainage Proposed <br /> ❑�J l Backflow Prevention for high hazard: <br /> Approved By: J Date: /4 J tat <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> ( FIRE ' EPARTMENT P Route 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: Mee <br /> Permit is Approved by Public Works <br /> PA <br /> See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: It Separate PW Permit is Required (Permit#: P , ,�. _ <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND Als located in this folder M1, ,, <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> I Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K, 002f, jr. Date:c '.''—/ ❑ Public Works has no scope---PW Not Re cared <br /> Additional Notes: .' l <br /> ELECTRICAL 1�-ri s'Ir� j. rV �bseulAib'!w 4r <br /> Additional Notes: to 2311°1 <br /> Approved By: Date: Approved By>Q_�s ,1le— Date: Va___/J,, <br />