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Intake &Approval Sheet • (FOR PERMIT STAFF ONLY) • PERMIT# 102011 'pZZ• <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W" Permit 0 OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size 0 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 Dwelling nits: <br /> Occupancy Load Total No.of Dwelling its: <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landsca•e Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Ty%e: Amount$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impac ee: Total $ <br /> Reason Fire Alarm Required: Calculated- Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes 0 No ❑Ever: School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 dots required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total$ ` <br /> \lb s) '1(1,6t I h ))lc 1 <br /> Approved By: Date: t,\ V7i2/, <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Ne-•ed if: <br /> '❑Sys Dev - ❑Traffic Mit Eval <br /> !Mite .rk or Drainage Proposed <br /> Approved By: COJAk Date: 1.f l,( 7,7� ❑B- flow Prevention for high hazard: <br /> (• ntal,medical,animals,mortuary,hospital, <br /> upportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Revi at end --- PW Review Worksheet <br /> Separate/Deferred Submittals Requir ❑This project also has a se..rate concurrent PW Review (Green Folder) <br /> ❑Fire Sprinklers ❑Fire Alarm •Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ❑ This Permit is Appr'. ed by Public Works <br /> 0 See PW Review I orksheet and associated attached items <br /> Fire Dept.Fees: ❑ A Separate P Permit is Required (Permit#: PW_, <br /> ❑ Review of A guilt Plans-NO FIRE FEE AND ❑ Is I. ated in this folder <br /> ❑ Minimal '- No Fire Scope-NO FIRE FEE 0 I- in a Separate Green Folder (join with this folder for permit issuance) <br /> ❑ Rev.• /Inspe on Sco.- -)ADD FIRE FEE ■ Will be issued separately (Separate Green Folder,PW issued ahead of Bldg) <br /> A••roved By: Y ' \,/ / Date: ❑ P gtic Works has no scope--- PW Not Required <br /> Ad.'ional Notes: <br /> EL RICAL/PLUMBING Y `D (�At) <br /> Additional Notes: "' <br /> MANt <br /> Approved By: Date: Approved By: Amm / Date: LI <br />