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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# 9�\ZO1 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building CI 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 ❑No ❑Yes , Fin/Unfin Nonresidential Use <br /> _ Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwellin. nits: <br /> Occupancy Load Total No.of Dwelling its: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landsca'a Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Ty•-: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System CI Not Req'd School Impact ee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Evere chool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additio .1 Notes: <br /> VALUATION CALCULATION: Total$ Z 904 Z S <br /> Approved B ---T' Date: \ . 2_l <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if: <br /> I DSys Dev Eval OTraffic Mit Eval <br /> i <br /> OSite Work or Drainage Proposed <br /> IApproved By: , ''+,/% Date:COO: pZ/ DBackflow Prevention for high hazard: <br /> i(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: OThis 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: ❑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 ❑ 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: ublic Works has no scope---PW Not Required <br /> Additional Note i 11(° 11`1 <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: /N Date: //I/Z, <br />