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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 2't . 036 <br /> BUILDING PLANNING <br /> Intake OK b Date: /2�a7A / Intake OK by: Assign To: • <br /> Date: <br /> Intake Comments: Intake Comments: <br /> • <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ M ke this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldk/Tl/ do/Rem Size 83 T .57 ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone <br /> Number of Stories 2— Overlay/Agreement <br /> Basement '1,1 No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction v6 Residential Use <br /> Occupancy Group 5 Proposed No.of Dwelli Units: <br /> Occupancy Load Total No.of Dwellin nits: <br /> Fire Sprinklers:JVUpdate Existing ❑New System aluot Req'd Planning/Lands pe Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee: pe: Amount$ <br /> Fire Alarm: El Update Existing El New System/Not Req'd School Imp ct Fee: Total $ - <br /> Reason Fire Alarm Required: Calcula d: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 121 No ❑E rett School Dist ❑Mukilteo School Dist <br /> Add!RCW 64.55 docs required prior to final? ❑Yes No A ditional Notes: <br /> VALUATION CALCULATION: Total$ goy 00o. Do <br /> Approved By: Date: • <br /> PUBLIC WORKS <br /> Intake OK by: . Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> IDSys Dev Eval ❑Traffic Mit Eval <br /> (DSite Work or Drainage Proposed <br /> Approved By /._; Date:/ c z,ert( =OBacktlow Prevention for high hazard: <br /> _(dental,medical,animals,mortuary,hospital, <br /> 'supportive housing) <br /> FIRE DEPARTMENT DRoute 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 iZire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑This Permit is Approved by Public Works <br /> ❑ 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 ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ggeview/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> i jr- <br /> Approved By: S fc:11.J1f('gate: / .-�� 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> /2._ <br />