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�p /. <br /> pp <br /> Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# 170 —Q <br /> • 1111 7 <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 65- Fyc), d ❑ Hold in Planning File Drawer /' <br /> Garage/Accessory Struct. Size E —001/ Zone <br /> Number of Stories 5— Overlay/Agreement / <br /> Basement ONo trYes , Fin/Unfin Nonresidential Use <br /> Type of Construction v 'A Residential Use <br /> Occupancy Group Proposed No.of Dw- ing Units: <br /> Occupancy Load ,5-6? Total No. of Dwell' g Units: <br /> Fire Sprinklers: El Update Existing MNew System ONot Req'd Planning/Lan•-cape Inspection Required before Final? ❑Yes El No <br /> Reason Sprinklers Required: "In Lieu"Fe Type: Amount$ <br /> Fire Alarm: ❑Update Existing flew System ONot Req'd School I •act Fee: Total $ <br /> Reason Fire Alarm Required: Calcul. ed: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? 1Yes 0 No ❑ erett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes IgiNo Ad•itional Notes: <br /> VALUATION CALCULATION: Total$ f 3,'10 VO <br /> Approved By: Date: <br /> PUBLIC WORKS <br /> 5 Intake OK by: Date: <br /> Additional Notes: Intake Comments: DPW Worksheet Needed if:p/1�v/cuss F`ovnoo O17c,.-7 17 -►M <br /> I❑Sys Dev Eval ❑Traffic Mit Eval <br /> ✓3 1// <br /> 06,-ei I❑Site Work or Drainage Proposed <br /> Approved By: Date: ' 1❑Backflow Prevention for high hazard: <br /> PP T G-�Zs € ' '7/0'�4 <br /> (dental,medial,animals,mortuary,hospital, <br /> supportive housing) <br /> FIRE DEPARTMENT DRoute 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 OCreate Green Folder ;:°Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Approved/by Public Works <br /> ❑ See PW Review V rksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate P ermit is Required (Permit#: PW <br /> ❑ Review of As-Built Plan -NO FIRE FEE AND ❑ Is to ted in this folder <br /> ❑ Minimal or No Fire ope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspe on 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: <br />