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Intake & Approval Sheet (FOR PERMIT STAFF ONLY) PERMIT# '036 <br /> BUILDING / PLANNING <br /> �'� <br /> Intake OK by 4. Date 2� /Z4li/7 Intake OK by: Date: e/i(!`r of <br /> Intake Comments: Intake Comments: Assign To: H(Qivi <br /> dere ./ paril- -- iciruA,ccove;i1. Leo 11-of <br /> Cum+ i- zne . <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 OK to Route to Other Departments <br /> Bldg/Tl/Addn/Rem Size 77/ <br /> Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size --- Zone 15-2 <br /> ,r <br /> Number of Stories / Overlay/Agreement Cin-froc't 11-Con-e. <br /> Basement gNo Oyes , Fin/Unfin Nonresidential Use an;i C <br /> Type of Construction V-- 13 Residential Use <br /> Occupancy Group U Proposed No.of Dwelling Units: -- <br /> Occupancy Load 3 7 Total No.of Dwelling Units: <br /> Fire Sprinklers: Ziupdate Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: .e -" -S:>-s "In Lieu" F--. pe: - ount$ <br /> Fire Alarm: pdate Existing ❑New System ❑Not Req'd School Impact Fee: Total <br /> Reason Fire Alarm Required: id 7/4G-J>--- Calculated: Credit: _ <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes Ia t No 0 = School Dist ❑Mu'• -o School Dist <br /> Add'I RCW 64.55 docs required prior to final? G❑Yes t2No Additional Notes: <br /> 7 <br /> VALUATION CALCULATION: Total$ /20 51-3-- <br /> ) <br /> a <br /> Approved By: Date: 6/2Z/I <br /> PUBLIC WORKS / <br /> Intake OK by: T— \ Date: glkl, l I(o 120/4 <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> I +6,I-TE12-.0- I ❑Sys Dev Eval ❑Traffic Mit Eval <br /> ....".Ib v'rt`.-t Y ct,,p,.i„r,OSite Work or Drainage Proposed <br /> / �� / (J� q ❑Backflow Prevention for high hazard: <br /> Approved By: ! Date: 6 / - tat, E Ne-rEv_,nct„ 14 Aea.- (dental,medical,animals,mortuary,hospital, <br /> 5"11-4`44 v£ ch qv,talc..% 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 /> Fire Sprinklers ❑Fire Alarm pother: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> 0 See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: 0 A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND 0 Is located in this folder <br /> Igl Minimal or No Fire Scope-NO FIRE FEE 0 Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE 0 Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> i <br /> Approved By:L�(37, Date: /'',,//G--` 5 /) -ublic Works has no scope---PW Not Required <br /> dditional Not-/.�j -�/ —,; ` /Zot'i <br /> ELECTRICAL <br /> 4t r+o...►AA— 'P f&...C, Wor-6e- "P£ z .-7-• -R..€0,.' <br /> Additional Notes: FSR. ?Att...v..4„ay t.--r- c-Vs,A, (=ES. -TV la//f 14 <br /> Approved By: Date: Approved By: Date: l <br /> 1 �i <br />