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Intake &Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# f;?LI 0 OIS 1 <br /> BUILDING nJ��1/ PLANNING <br /> /�� <br /> Intake OK by: Date: Intake OK by: V 6 Assign To: O crel 41- Date:I0/ 7/Zd <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 I.3I/.¢Gj $.0. ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size — Zone t - I rvt JO <br /> Number of Stories Cp Overlay/Agreement <br /> Basement No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction I' fk, \I _4 Residential Use y IJ H-i ~ M/1`( <br /> Occupancy Group S-.2, ‘t.-.2. Proposed No.of Dwelling Units: 'w <br /> Occupancy Load S-S€2 Total No.of Dwelling Units: Lam,, <br /> Fire Sprinklers: DUpdate Existing ®New System ❑Not Req'd Planning/Landscape Inspection Required before Final?)IYes ❑No <br /> Reason Sprinklers Required: '%.-Z- "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: DUpdate Existing tNew System ❑Not Req'd School Impact Fee: Total $ 1(oc1 S S O <br /> Reason Fire Alarm Required: >3d)Or' ` Calculated:i SS 430 Credit: <br /> RCW 64.55 MF worksheet req'd for permit? El No Ldverett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? k74 Yes ❑No Additional Notes: ' \yl (e4, <br /> VALUATION CALCULATION: Total$ I S,84(0)c,44 <br /> (1l4-, (56)0 iQ_ 1 ,, 1, -2/ 2so 55 2,-v 7C 4 36)6 = (Siloil 350 <br /> ( 2R(344) (1 Dtp)= 2, 3 ►/2.4/4- Approved By: IL, Date: , I®,ZI <br /> UBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if:: <br /> €OSys Dev Eval DTraffc Mit Eval <br /> ©Site Work or Drainage Proposed <br /> Approved By: yil'i2� Date: (QNo2,4 �Backflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT ❑Route 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 /> 2FIre Sprinklers gkire Alarm ❑Other: AND OCreate Green Folder ❑Submitted Previously ❑Deferred <br /> • <br /> Additional Notes: `, ❑ This Permit is Approved by Public Works '' <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: J'A Separate PW Permit is Required (Permit#: PW 2,p1(-p4 q ) <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 /> IA-Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: y 6(17E0n Date://-9)--20 ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br />