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Intake & Approval Sheet I* (FOR PERMIT STAFF ONLY) • PERMIT # ?EM2,,—o%', <br />BUILDING <br />Intake OK by: Date: <br />Intake Comments: <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 El 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 docs required prior to final? ❑Yes ❑ No <br />VALUATION CALCULATION: Total $ IS000. 00 <br />Additional Notes: <br />Approved Date: Q Zd Z0 <br />FIRE DEPARTMENT <br />Srr--essp__arateI Deferred. Submittals Required: <br />�,cr�ire Sprinklers OaFire Alarm ❑Other: <br />Additional Notes: 45 <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 Sco e - ADD FIRE FEE <br />Approved By: Date: Z Z Z <br />v � <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNING <br />Intake OK by: t`' Assign ToiTtt� Date <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ oute to Historic Reviewer <br />15TOK to Route to Other Departments <br />❑ Hold in Planning File Drawer <br />Zone <br />— Z <br />Overlay/Agreement <br />Nonresidential Use <br />f Gt <br />Residential Use <br />Proposed No. of Dwelling Units: <br />Total No. of Dwelling Units: <br />Planning/Landscape Inspection Required before Final? ❑Yes Evo <br />"In Lieu" Fee: Type: Amount $ <br />Sch"act Fee: Total <br />Calculated: _ Credit: <br />❑Evere cool Dist ilteo School Dist <br />Additional Notes: p . t�r r mvtwed q/ <br />apt 'IftiS <br />Approved By: Date: Ig <br />PUBLIC WORKS <br />Intake OK by: Date: 2 <br />Intake Comments: �/� _-PW Worksheet Needed if.• <br />6W 4�/?,/�r (�( e t. []Sys Dev Eval ❑Traffic Mit Eval <br />[]Site Work or Drainage Proposed <br />❑Backfilow Prevention for high hazard: <br />'(dental, medical, animals, mortuary, hospital, <br />'supportive housing) <br />... _...................... ........... ... ............... .................................................... .................. <br />❑ Route 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 />❑ This 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 (join 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: Z000 <br />