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Intake & Approval Sheet 9 (FOR PERMIT STAFF ONLY) 1 PERMIT # <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 />&25 4 <br />Garage/Accessory Struct. Size <br />Number of Stories <br />- <br />Basement <br />JONo ❑Yes , Fin / Unfin <br />Type of Construction <br />— [ij <br />Occupancy Group <br />Occupancy Load <br />4+ <br />Fire Sprinklers: 9Update 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 docs required prior to final? ❑Yes 1ANo <br />VALUATION CALCULATION: Total $ k851 CDo <br />Additional Notes: <br />Approved By: xeyDate: I g <br />FIRE DEPARTMENT <br />Separate / Deferred Submittals Required: <br />P!Eire Sprinklers ire Alarm []Other: 440 <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 ope - ADD FIRE FEE <br />Approved By: Date: Zp 1,C) <br />v <br />ELECTRICAL <br />Additional Notes: <br />Approved By: Date: <br />PLANNII�N,�G"" <br />Intake OK by: Assign To: i�l.i - Date: 16 11131 2b <br />Intake Comments: <br />❑ Attach to Project No. <br />❑ Route to Historic Reviewer <br />to Route to Other Departments <br />O—OK <br />Hold in Planning File Drawer <br />Zone <br />Overlay/Agreement <br />Nonresidential Use <br />p`— <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 Lie " Fee: Type: Amount $ <br />School mpact ee: Total <br />Calcula d: C edi <br />❑Evere chool Dist ❑Mu eo School Dist <br />Additional Notes: <br />Approved By: Date:[ ?j <br />PUBLIC WORKS <br />Intake OK by: Date: <br />:........ ... ................. ..... ................ ...... ..................... ............... ....... ... ..... .................. ...... . <br />Intake Comments: PW Worksheet Needed if: <br />`]Sys Dev Eval ❑Traffic Mit Eval <br />[]Site Work or Drainage Proposed <br />€OBackflow Prevention for high hazard: <br />;(dental, medical, animals, mortuary, hospital, <br />,supportive housing) <br />e.....................................................................................................,.....,,............. .....,...........,........ <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 />❑ WIII 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: �Q 2� <br />