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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) • PERMIT# <br /> BUILDING PLANNING <br /> Intake OK by: Date: 1 IQ Intake OK by: Date: <br /> Intake Comments. Intake Comments: Assign To: r-P/li <br /> ❑ Route to Commercial Building ❑ Attach to Project No. <br /> ❑ Route to Residential Building El Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/T Addni-em Size 24.S $F ❑ Hold in Planning File Drawer <br /> Garage/ ccesso Struct.Size 4 50 5. Zone I2-—2 <br /> Number of S odes I Overlay/Agreement P-1\/P,(5 f E (S-f {e <br /> Basement gNo ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use ,5 <br /> Occupancy Group IZ Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: 1 <br /> Fire Sprinklers: DUpdate Existing ONew System ❑Not Req'd Planning/Landscape Inspection Requir-: •efore Final? ❑Yes 1'lo <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: ❑Update Existing El New System ❑Not Req'd School Impact Fee: Tot. <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes f No El Ever- -chool Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 21-No Additional Notes: <br /> VALUATION CALCULATION: Total$ 1St457 <br /> Approved iL�i Date: . / 1 sr�� <br /> PUBLIC WORKS <br /> Intake OK by: 'rJ Date: /3_'Zi tat <br /> Additional Notes: Intake Comments: PW worksheet Needed if: <br /> S f Aga•-u.% ( (Sys Dev Eval ❑Traffic Mit Eval <br /> 5 5"7 S,c- a 8Id P6ite Work or Drainage Proposed <br /> 1 y erht l• <br /> Approved By: c � Date: 71/do AAA notes s 'to Ua PfYI'►1i �Backflow Prevention for high hazard: <br /> �./ for TEsc t downs ,) �oeit slb (dental,medical,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT I'0: 'oute 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 ❑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: El 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: ❑ Public Works has no scope PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: � Date: 744 / Z p i- <br />