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Intake & Approval Sheet FOR PERMIT STAFF ONL PERMIT#"�,�'�" 1) 4gli <br /> 3 <br /> BUILDING - PLANNING <br /> Intake OK by: Date: Intake OK b} ? - Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ 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 <br /> Basement I No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group / 2- 3 Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwellin• nits: <br /> Fire Sprinklers: ❑Upd a Existing El New System ONot Req'd Planning/Landsc:pe Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers R quired: "In Lieu"Fee:T pe: Amount$ <br /> Fire-Alarm: pdate-Existing El New System-0 Not Req'd School Imp. t Fee: Total $ <br /> Reason Fire Alarm Required: Calculat.:: Credit: <br /> RCW 64.55 MFworksheet req'd for permit? ❑Yes ❑ No ❑Ev- ett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64/55 docs required prior to final? DYes ❑No Additional Notes: <br /> VALUATIO CALCULATION: Total$ (,{� roe, <br /> Approved By( -) Date: ,zq,Zjuj <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> t — 12,1L ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ( ❑Site Work or Drainage Proposed <br /> Approved By: 1-4? Date: 8/�1��� ❑BackFlow Prevention for high hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT ❑Route 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 /> ❑Fire Sprinklers El Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved by Public Works <br /> 0 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 ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE J El Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: `�3 Date: 74� w Public Works has no scope PW Not Required <br /> C��L / A••itional Notes: <br /> LECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: 7T . . $ Date: 67a f <br />