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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# T O 1,--4"®0 7 <br /> BUILDING PLANNING <br /> Intake OK by: Cfrth Date: 2,/Zo /20 Intake OK by:0Z Assign To: Dater/./2e) <br /> Intake Comments: Intake Comments: 3 <br /> 3 <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> 10 s.ute to Residential Building ❑ Route to Historic Reviewer <br /> I Make this a"W" Permit K to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size 5 3 2.. Sri, Zone P.--I <br /> Number of Stories ` Overlay/Agreement <br /> Basement INo DYes , Fin/Unfin Nonresidential Use -- <br /> Type of Construction Residential Use S=*. <br /> Occupancy Group Alt,{ Proposed No. of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: <br /> Fire Sprinklers: DUpdate Existing ❑New System ONot Req'd Planning/Landscape Inspection Requ' d before Final? ❑Yeslo <br /> Reason Sprinklers Required: " n i "Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact e : T $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No DEve chool Dist ❑Mukilteo Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ONo Additional Notes: St'fb�` IL c J uirve IJ ►sect v,u-col. <br /> VALUATION CALCULATION: Total $ 9 8 1 clCPg, ex IS S►�sil > ta�1 t k G, too fl/\lz � yrli(di <br /> 532. € `F 8 Sl('�-L� U se-I 1�a G . <br /> 3 3o o 71 Approved By: Date: 1 I 2.6 <br /> PUBLIC WORKS <br /> Intake OK b ,.. b ----- Date: . /� ��FJ <br /> Y .�� <br /> Additional Notes: /5.7 # ./ G Intake Comments: n, /6 PW Worksheet Needed if. <br /> 53 2 9- Cxkl i ► l Sys Dev EvaY "(]Traffic Mit Eval <br /> si"r .sys DEiv. D€ Site Work or Drainage Proposed <br /> Approved By: �1 Date:3 9/� • N 1 on gl j '/I'll7L l0Backflow Prevention for high hazard: <br /> /� ff J (dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> :............................................................................................................................................................. <br /> FIRE DEPARTMENT EfRoute 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 DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: p This Permit is Approved by Public Works <br /> IZI-see PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 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 /> O 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: ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By:-:2 /.,! /,•/- Date: 6z/24 Jze,Lc, <br /> 3/3 <br />