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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) 0 PERMIT# 'j216 4- Oq2- <br /> BUILDING PLANNING Intake OK by: Date: Intake OK by i _ Assign To: )d+p <br /> • Date:4/24/21 <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ oute to Historic Reviewer <br /> ElMake this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 121- 0 Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone —2. <br /> Number of Stories / Overlay/Agreement �< <br /> Basementlo ❑��Yeyys��, Fin/Unfin Nonresidential Use . <br /> Type of Construction cLJ",`L Residential Use cr1i <br /> Occupancy Group �t'" Proposed No.of Dwelling Units: <br /> Occupancy Load di�L Total No.of Dwelling Units: <br /> Fire Sprinklers: El Update Existing ❑New System urNot Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: �� "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: CI Update Existing 0 New System I(dNot Req'd School Impact Fe • <br /> Reason Fire Alarm Required: . Calc e • Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes P?`` o verett School Dist 0 Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes al No Additional Notes: O ex c•• JUu geoeutio44 of <br /> VALUATION CALCULATION: Total$ 1d <br /> A)i roved By:A 1.2,312.02.4 <br /> PUBLIC WORKS` <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: {PW Worksheet Needed if• <br /> ',n$ '(J\,d�o / 14 IDSys Dev Eval OTraffic Mit Eval <br /> /� I.OSite Work or Drainage Proposed <br /> Approved By: Date:s f,�,i I OBackflow Prevention for high hazard: <br /> fff _ i(dental,medical,animals,mortuary,hospital, <br /> !supportive housing) <br /> - FIRE DEPARTMENT DRoute 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 DOther: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works " <br /> ❑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 ❑ 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 /> O Review/Inspection Scope-ADD FIRE FEE 0 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: Am Date: 4 Q 2a, A <br /> 4, <br />