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• 0 --P i <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# b (I' uo-M I <br /> BUILDING PLANNING � <br /> Intake OK by: P L- j Date: Intake OK by: J Date: Q` /.2 I/i 1 I <br /> Intake Comments: Intake Comments: Assign To: (V ti e 1 5 <br /> ❑ Route to Commercial Building 0 Attach to Project No. nA tZ 0 Luo <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit ❑ OK to Route to Other Departments <br /> Bldgfl • • .- - - El Hold in Planning File Drawer <br /> Vg <br /> IUC-tLc, <br /> , . 5rr.4---Dv CIic4-v31Garay — Zone {'1 <br /> Numt ,-.--) / 4:/1 .4). <br /> S_ / Z �,� Overlay/Agreement <br /> Base. Q Nonresidential Use <br /> / <br /> Type x /.6 (.7, — Residential Use ;1 1 1 i,1 ,� t 1-/ E.-i,/ .( <br /> Occu _� Proposed No. of Dwelling Units: -- d <br /> Occ c � 3 c� , �_ Total No. of Dwelling Units: �'�" <br /> Fire E X. I'd Planning/Landscape Inspection Required before Final? IgYes ❑No <br /> Reas7 Z "In Lieu" Fee:Type: Amount$ <br /> 5- 3 — <br /> Fire I / "'> - I'd School Impact Fee: Total $ 13(2 6 <br /> Reas `� � _ Ca culated: Credit: <br /> RCW aYQ �" > veett School Dist. ❑Mukilteo School Dist <br /> Add'I I � �s-} y is � Additional Notes: Dist 0OL.. PcR*- <br /> VALU. �l _ "Z�p l�r OIJI>'r <br /> Approved By:��5 TZ Date: <br /> PUBLIC WORKS <br /> fly)/ /'ee't7if4i iU G, it/ S S 66` Intake OK by:22,_,.., Date: 0//70/7 <br /> Additional Notes: V Intake Comments: PW Worksheet Needed if. <br /> p Y i I J 'Sys Dev Eval ZTraffic Mit Eval <br /> thin At/A, 61-1)6• Site Work or Drainage Proposed <br /> Approved By: Date: '/-�- r ❑Backflow Prevention for higir hazard: <br /> (dental,medical,animals,mortuary,hospital, <br /> ��,,(( supportive housing) <br /> 1Sl <br /> FIRE DEPARTMENT , Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: KThis project also has a separate concurrent PW Review(Green Folder) <br /> Off—ire Sprinklers 0-Fire Alarm ❑Other: AND NrCreate Green Folder ❑Submitted Previously El 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 /> 2 Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: K,3imw n Date: /v-3--/ 47 0 Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />