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Intake &Approval Sheet 0 (FOR PERMIT STAFF ONLY) S PERMIT# lG '-(:)(2f3 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: 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 U W' <br /> Number of Stories Overlay/Agreement — <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use (} C-e <br /> Type of Construction Residential Use — <br /> Occupancy Group Proposed No.of Dwelling Units: — <br /> Occupancy Load Total No.of Dwelling Units: — ,/ <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes o <br /> Reason Sprinklers Required: "In Lieu"Fees : rig$ <br /> Fire Alarm: El Update Existing ❑New System ONot Req'd School Impact Fee: I o <br /> Reason Fire Alarm Required: Calculated: 't: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Ev chool Dist ❑Mukilteo Schoo <br /> Add'I RCW 64.55 does required prior to final? ❑Yes El No Additional Notes: Iri-l-e a into Wo/- Ovi I ( Cif <br /> VALUATION CALCULATION: Total$ -exeS o-(1Ce Spo-Ce <br /> Approved By: thig Date: 61/I(Q/I 1 <br /> PUBLIC WORKS <br /> Intake OK by: —r1.\ Date: 6 f l .o /I <br /> Additional Notes: pc-NA oL.t-rutst h/INE.� �1 's7 Intake Comments: PW Worksheet Needed if: <br /> W S-r .vC.itAtAl.. -pe►.,�.et.i-cl. ,t, I ��TE�"`O'z IOSys Dev Eval ❑Traffic Mit Eval <br /> p4 0 S Co—PC I OSite Work or Drainage Proposed <br /> Approved By: Date: (!O I, =OBackflow Prevention for high hazard: <br /> / / I(dental,medical,animals,mortuary,hospital, <br /> isupportive 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 /> El 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: 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 /> ❑ 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: blic Works has no scope--- PW Not Re red <br /> Additional No • <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 42-- <br />