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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) <br />PERMIT #— \O� — ��� <br />BUILDING <br />Intake OK by: Date: <br />Intake Comment <br />❑ Route to Commercial Building <br />❑ Route to Residential Building <br />❑ Make this a "W" Permit <br />Bldg/TI/Addn/Rem Size <br />Garage/Accessory Struct. Size <br />Number of Stories <br />Basement <br />[]No ❑Yes , Fin / Unfin <br />Type of Construction <br />Occupancy Group <br />Occupancy Load <br />Fire Sprinklers: ❑Update Existing ❑New System []Not Req'd <br />Reason Sprinklers Required: <br />Fire Alarm: []Update Existing ❑New System ❑Not Req'd <br />Reason Fire Alarm Required: <br />RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No <br />Add'I RCW 64.55 dots required prior to final? ❑Yes ❑No <br />VALUATION CALCULATION: Total $ <br />Additional Notes: <br />Approved By: Date: <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />❑Fire Sprinklers ❑Fire Alarm ❑Other: <br />Additional Notes: <br />Fire Dept Fees: <br />❑ Review of As -Built Plans - NO FIRE FEE <br />❑ Minimal or No Fire Scope - NO FIRE FEE <br />❑ Review Inspection Scope -ADD FIRE FEE <br />Approved By: Date: <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: Date: U j <br />Intake Comments: Assign To: <br />ttach to Project o W <br />No. UI I <br />Route to Historic Reviewer <br />❑ OK to Route to Other Departments <br />Hold in Planning File Drawer <br />Zone <br />— <br />Overlay/Agreement <br />Nonresidential Use <br />Vl <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br />"In Lieu" Fee —Type: unt $ <br />School Impact Fee: al $ <br />Calculated: it: <br />❑ School Dist ❑Mukilteo School <br />Additional Notes: <br />Approved By: Date: • ZZ.. <br />BLIC WORKS <br />Intake OK by:— 13 Date: f 4 11 9 <br />'------ •----- ---------------------------- <br />Intake Comments: :PW Worksheet Needed if., <br />❑Sys Dev Eval ❑Traffic Nit Eval <br />W ai:_ss �aw><�•oNl []Site Work or Drainage Proposed <br />❑Backflow Prevention for high hazard: <br />(dental, medical, animals, mortuary, hospital, <br />;supportive housing) <br />oute this folder for PW Review at end -- PW Review Worksheet <br />❑This project also has a separate concurrent PW Review (Green Folder) <br />AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br />his Permit is Approved by Public Works <br />❑ See PW Review Worksheet and associated attached items <br />❑ A Separate PW Permit is Required (Permit#: PW ) <br />AND ❑ Is located in this folder <br />❑ Is in a Separate Green Folder Qom with this folder for permit issuance) <br />❑ Will be Issued separately (Separate Green Folder, PW issued ahead of Bldg) <br />❑ Public Works has no scope — PW Not Required <br />Additional Notes: <br />Approved By: Date: Z/1422 <br />