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Intake & Approval Sheet • (FOR PERMIT STAFF ONLY) 40 PERMIT#'9201 002- 1 <br /> _ BUILDING — _ PLANNING <br /> ,e�1,L/� ri f- <br /> Intake OK by: Date: Intake OK by:1'��� Assign To: !J l,�X!.:✓ Date: 1 ��• _ <br /> Intake Comments: Intake Comments: <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 f.OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct. Size Zone -- ,r <br /> 1�7 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes , Fin/Unfin Nonresidential Use ','.,)L. 1` <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No. of Dwelling Units: <br /> Occupancy Load Total No. of Dwelling Units: <br /> /, <br /> Fire Sprinklers: ❑Update Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes L�A'No <br /> Reason Sprinklers Required: "In-Lieu" Fee: Type:\ Amount$ <br /> Fire Alarm: ❑Update Existing El New System ❑Not Req'd School Impact Fee: .otal $ \ <br /> Reason Fire Alarm Required: Calculated:, Credit: , <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes El ❑Eve\e)t School Dist �liVlukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ 9 `-OC`6U <br /> Approved By: Cil✓!�`> Date: i , , I i,'h/,/' ;, <br /> PUBLIC WORKS <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> CI site Work or Drainage Proposed <br /> Approved B Date j//'Yf,Z p <br /> ❑Backflow Prevention for high hazard: <br /> :(dental,medical,animals,mortuary,hospital, <br /> 'supportive housing) <br /> FIRE DEPARTMENT DRoute 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 /> DFire Sprinklers DFire Alarm DOther: AND DCreate Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ 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 /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ 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 /> Approved By: V..1(NocAlh Date:itt 2)j 9 O ❑ Public Works has no scope--- PW Not Required <br /> Additional Notes: --pvsj �c.R-4.4 4 T ---Ris12oos_023 <br /> ELECTRICAL R.-Ld-r t2—C--c1•3,R.-ED c—,g,,,.� <br /> Additional Notes: V'o+t',:0 ea-, e_4-,.3c.(..L .e,® <br /> Approved By: Date: Approved By:' )(�J_ F,,- Date: /L '. ,p/ ,, <br /> G„ <br />